division of vaccines and immunisation comprehensive multi year

REPUBLIC OF KENYA

MINISTRY OF PUBLIC HEALTH AND SANITATION

DIVISION OF VACCINES AND IMMUNISATION COMPREHENSIVE MULTI YEAR PLAN

2013-2017

Kenya DVI Comprehensive Multi-Year Plan 2013-2017 2

TABLE OF CONTENT

TABLE OF CONTENT......................................................................................................................................... 2

LIST OF TABLES ................................................................................................................................................ 4

LIST OF FIGURES .............................................................................................................................................. 5

LIST OF ANNEXES ............................................................................................................................................ 6

LIST OF ACRONYMS ......................................................................................................................................... 7

FORWARD ..................................................................................................................................................... 11

1 BACKGROUND ..................................................................................................................................... 13

1.1 HEALTH SITUATION IN KENYA .............................................................................................................................. 13 1.2 CHILD HEALTH INTERVENTIONS IN KENYA .............................................................................................................. 15 1.3 COVERAGE TRENDS FOR IMMUNIZATION .............................................................................................................. 15 1.4 HEALTH SECTOR PRIORITIES ................................................................................................................................ 18

2 HEALTH CARE DELIVERY SYSTEM IN KENYA ......................................................................................... 20

2.1 EXTERNAL POLICY ENVIRONMENT ....................................................................................................................... 20 2.2 SECTOR STRATEGIC FRAMEWORK, AND DOCUMENTS .............................................................................................. 21

2.2.1 Policy level documents ....................................................................................................................... 22 2.2.2 Strategic level documents .................................................................................................................. 22 2.2.3 Investment level documents .............................................................................................................. 22 2.2.4 Operational level documents ............................................................................................................. 23

2.3 SECTOR TARGETS AND INDICATORS ...................................................................................................................... 23 2.4 RECAP OF SECTOR STRATEGIC PRIORITIES .............................................................................................................. 23

2.4.1 Recap of Vision 2030 .......................................................................................................................... 23 2.4.2 Recap of the First Medium-Term Plan, 2008–2012 .......................................................................... 24 2.4.3 Recap of NHSSP II 2005–2012 ............................................................................................................ 24

3 IMMUNIZATION PROGRAMME IN KENYA ........................................................................................... 26

3.1 SERVICE DELIVERY ............................................................................................................................................. 26 3.2 VACCINE SUPPLY, QUALITY AND LOGISTICS ........................................................................................................... 26 3.3 DISEASE SURVEILLANCE ...................................................................................................................................... 28 3.4 ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION .................................................................................... 28 3.5 GOAL OF ROUTINE IMMUNIZATION ...................................................................................................................... 30 3.6 IMMUNIZATION SCHEDULE FOR KENYA................................................................................................................. 30

4 IMMUNIZATION SYSTEM COMPONENTS ............................................................................................. 32

4.1 SERVICE DELIVERY ............................................................................................................................................. 32 4.2 VACCINE SUPPLY, QUALITY AND LOGISTICS ........................................................................................................... 32 4.3 DISEASE SURVEILLANCE ...................................................................................................................................... 33 4.4 ADVOCACY, SOCIAL MOBILIZATION AND COMMUNICATION .................................................................................... 34

5 SITUATION ANALYSIS .......................................................................................................................... 35

5.1 ROUTINE IMMUNIZATION PERFORMANCE, GAPS AND CHALLENGES ......................................................................... 35 5.2 POLIO ERADICATION .......................................................................................................................................... 39 5.3 ACCELERATED DISEASE CONTROL ......................................................................................................................... 40

6 PRIORITIES, OBJECTIVES AND MILESTONES FOR EPI ............................................................................ 42

7 IMPLEMENTATION PLAN ..................................................................................................................... 49


8 COSTING, FINANCING AND FINANCIAL SUSTAINABILITY ..................................................................... 59

8.1 COSTING AND FINANCING METHODOLOGY ............................................................................................................ 59 8.2 MACROECONOMIC INFORMATION ....................................................................................................................... 61 8.3 COST PROJECTIONS 2011-2015 FOR IMMUNIZATION PROGRAMME ........................................................................ 61 8.4 COST PROFILE ................................................................................................................................................... 62 8.5 BASELINE FINANCING ......................................................................................................................................... 63 8.1 COST BY IMMUNIZATION STRATEGY ..................................................................................................................... 64 8.2 PROJECTED FUTURE RESOURCE REQUIREMENTS FOR IMMUNIZATION FROM ALL SOURCES FROM 2011-2015. ............... 65 8.3 PROJECTED FUTURE FINANCING: SECURED, PROBABLE AND GAPS FOR IMMUNIZATION FROM 2011-2015. ................... 66

9 ANNEXES ............................................................................................................................................. 71

9.1 ANNEX 1: ACTIVITY TIMELINE 2011-2015 ........................................................................................................... 71 9.2 ANNEX 2: ANNUAL OPERATIONAL PLAN 6 (AOP 6) FAMILY HEALTH DEPARTMENT .................................................... 78 9.3 ANNEX 3: ANNUAL WORK PLAN 2011/2012, DIVISION OF VACCINES AND IMMUNIZATION ........................................ 79 9.4 ANNEX 4: USING GIVS FRAMEWORK AS A CHECKLIST ............................................................................................. 93


LIST OF TABLES

TABLE 1: TABLE HEALTH SECTOR STRATEGIC DOCUMENTS ............................................................................................................ 21 TABLE 2:CURRENT ROUTINE VACCINATION SCHEDULE FOR CHILDREN UNDER 1 YEAR ............................................................ 30 TABLE 3:SITUATIONAL ANALYSIS OF ROUTINE EPI BY SYSTEM COMPONENTS BASED ON PREVIOUS YEARS' DATA (2007-2009) ........................................................................................................................................................................................................ 37 TABLE 4:SITUATIONAL ANALYSIS BY ACCELERATED DISEASE CONTROL INITIATIVES, BASED ON PREVIOUS YEARS' DATA

(2007-2009) ......................................................................................................................................................................................... 41 TABLE 5:NATIONAL OBJECTIVES AND MILESTONES, AFR REGIONAL AND GLOBAL GOALS ......................................................... 42 TABLE 6: SERVICE DELIVERY AND PROGRAMME MANAGEMENT .................................................................................................... 49 TABLE 7: ADVOCACY AND COMMUNICATION ...................................................................................................................................... 55 TABLE 8: SURVEILLANCE........................................................................................................................................................................ 56 TABLE 9:VACCINE SUPPLY QUALITY AND LOGISTICS ........................................................................................................................ 56 TABLE 10: INPUTS TO DIFFERENT EPI SYSTEMS COMPONENTS ...................................................................................................... 59 TABLE 11:MACRO ECONOMIC TRENDS IN KENYA, 2010 – 2015 ................................................................................................. 61


LIST OF FIGURES

FIGURE 1:TOP CAUSES OF OUTPATIENT MORBIDITY IN KENYA ....................................................................................................... 14 FIGURE 2:TRENDS IN HEALTH IMPACT INDICATORS (1994-2008) ............................................................................................ 15 FIGURE 3:TRENDS OF DTP 3 IN KENYA, 1980-2008 ..................................................................................................................... 16 FIGURE 4:PROPORTION OF DISTRICTS WITH AT LEAST 80% DTP3 COVERAGE AMONG CHILDREN 12-23 MONTHS. .......... 17 FIGURE 5:DTP3 COVERAGE TRENDS BY RESIDENCE AND BY MOTHER'S LEVEL OF EDUCATION ................................................. 17 FIGURE 6: DTP3 COVERAGE AMONG CHILDREN 12-23 MONTHS BY PROVINCE ........................................................................... 18 FIGURE 7: PILLARS OF KENYA’S DEVELOPMENT FRAMEWORK – VISION 2030 ........................................................................... 19 FIGURE 8: ORGANOGRAM OF DIVISION OF VACCINES AND IMMUNIZATION: ..................... ERROR! BOOKMARK NOT DEFINED. FIGURE 9: TRENDS OF IMMUNIZATION PERFORMANCE FOR SELECTED INDICATORS, 1992-2009, KENYA ............................ 35 FIGURE 10: ROUTINE IMMUNIZATION PROGRAMME EXPENDITURE BREAKDOWN ......... ERROR! BOOKMARK NOT DEFINED. FIGURE 11: BASELINE FINANCING PROFILE ........................................................................... ERROR! BOOKMARK NOT DEFINED. FIGURE 12: COSTS BY STRATEGY .............................................................................................. ERROR! BOOKMARK NOT DEFINED. FIGURE 13: PROJECTION OF FUTURE RESOURCE REQUIREMENTS 2011-2015 ............... ERROR! BOOKMARK NOT DEFINED. FIGURE 14: PROJECTION OF FUTURE FINANCING GAP ........................................................... ERROR! BOOKMARK NOT DEFINED. FIGURE 15: THE FUNDING GAP AND SELECTED INDICATOR .............................................................................................................. 70


LIST OF ANNEXES

i. ANNEX 1: Action plan & timeline for 2011-2015

ii. ANNEX 2: AOP 6

iii. ANNEX 3: First year annual plan 2011

iv. ANNEX 4: GIVS checklist

v. ANNEX 5: Logistics forecasting tool [Soft copy]

vi. ANNEX 6: Costing tool [Soft copy]


LIST OF ACRONYMS

AD Auto Destruct (syringes)

AEFI Adverse Events Following immunization

AFP Acute Flaccid Paralysis

AIDS Acquired Immune Deficiency Syndrome

AIE Authority to Incur Expenditure

AOP Annual Operation Plan

BCC Behaviour Change and Communication

BCG Bacille Calmette-Guerin (Vaccine)

CAG Cash Assistance to Government

CBAW Child Bearing Age Women

CBHC Community Based Health Care

CBO Community Based Organization

CBS Central Bureau of Statistics

CDC Communicable Disease Control

CFC Chloro Flouro Carbon

cMYP Comprehensive Multi Year Plan

CORPS Community Own Resource Persons

DALYs Disability Adjusted Life Years

DANIDA Danish Aid National Development Agency

DARE Decentralized Aids and Reproductive

DDSC District Disease Surveillance Coordinator

DIFD Department for International Development

DFH Divison of Family Health

DHE Division of Health Education

DHEO District Health Education Officer

DHMT District Health Management Team

DHP District Health Programme

DoHP Department of Health promotion

DMOH District Medical Officer of Health


DMS Director of Medical Services

DPT/ (DTP) Diphtheria Pertusis and Tetanus

DQA Data Quality Audit

DRCO District Registered Clinical Officer

DVI Division of Vaccines and Immunization

EPI Expanded Programme on Immunization

FBO Faith Based Organization

FIC Fully Immunized Children

GAVI Global Alliance for Vaccines and Immunization

GDP Gross Domestic Product

GIVS Global Immunization Vision and Strategy

GOK Government of Kenya

HepB Hepatitis B

Hib Haemophilus influenza type b

HIS Health Information Systems

HIV Human Immunodeficiency Virus

NHSSP National Health Sector Support Programme

ICC Inter Agency Coordination Committee

IDS Integrated Disease Surveillance

IDSR Integrated Disease Surveillance & Response

IEC Information Education and Communication

IMCI Integrated Management of Childhood Illnesses

JICA Japan International Agency

JPWF Joint Program of Work and Funding

KBC Kenya Broadcasting Corporation

KDHS Kenya Demographic and Health Survey

KEMRI Kenya Medical Research Institute

KEMSA Kenya Management and Supplies Agency

KEPH Kenya Essential Packages for Health

KEPI Kenya Expanded Programme on Immunization


KHPF Kenya Health Policy Framework

KMTC Kenya Medical Training College

MCH Maternal Child Health

MDGs Millennium Development Goals

MDVP Multi Dose Vial Policy

MLM Mid Level Management

MNT Maternal Neonatal Tetanus

MoH Ministry of Health

MTEF Mid Term Expenditure Framework

MTP Medium Term Plan

MTRH Moi Teaching and Referral Hospital

MYP Multi Year Plan

NCPD National Council Population Development

NGO Government of Kenya

NID National Immunization Days

NPCC National Polio Certification Committee

NPEV Non-Polio Enteroviruses

NPHL National Public Health Laboratories

NPEC National Polio Expert Committee

NNT Neonatal Tetanus

OJT On the Job Training

OPV Oral Polio Vaccine

PDSC Provincial Disease Surveillance Committee

PHC Primary Health Care

PHEO Provincial Health Education Officer

PHI&RO Provincial Health Information and Records Officer

PHMT Provincial Health Management Team

PHO Public Health Officer

PHT Public Health Technician

PRSP Poverty Reduction Strategy Paper


PS Permanent Secretary

RED Reaching Every District

SIA Supplemental Immunization Activities

SDP Service Delivery Point

SNID Supplemental National Immunization Days


FORWARD

The Ministry of Public Health & Sanitation through the Division of Vaccines and Immunization aims to increase access to immunization services nationwide in order to reduce morbidity and mortality due to vaccine preventable diseases. This is in acknowledgement of the proven fact that immunization is the most cost effective intervention for vaccine preventable diseases. The reduction of infant and child morbidity and mortality in line with the United Nations Millennium Development Goals (MDG 4) by the end of this Multi Year Plan, 2015 cannot be over emphasized. The other major consideration is to implement the WHO/UNICEF Global Immunization Vision & Strategy (GIVS), Global Vaccine Action Plan (GVAP) and Decade of Vaccines (DoV) which challenges national governments to immunize more people, from infants to seniors, with a greater range of vaccines and new technologies. Routine immunization currently includes OPV, BCG, Pentavalent (DPT-Hib-Hep), PCV10, Measles plus Vitamin A with Rotavirus vaccine introduction scheduled for next year 2013. The Division is also giving hepatitis B vaccine for health workers and meningococcal vaccine for travelers proceeding for Hajj during the period of this MYP. The non-EPI vaccines include typhoid vaccine for food handlers and other special populations at high risk, anti rabies vaccine, anti snake venom and yellow fever vaccine for travellers. This multi year plan 2011-2015will serve as a reference point in the implementation of immunization activities and the preparation of annual action plans. The cMYP highlights the national goals, objectives & strategies for the improvement of the health of Kenyans in reference to specific vaccine preventable diseases. The Government of Kenya recognises vaccination as a high impact intervention of national importance and has projected to continue supporting the costs of expansion of immunization services. It is anticipated that the development partners and agencies that have assisted the Government of Kenya so far in the immunization arena will continue with us for the duration of the cMYP. The success of the immunization programme depends significantly on adequate and timely financing of all proposed activities. Other contributory factors include committed coordination through the Child Health Inter-agency Coordinating Committee (ICC) and other bodies such as the Kenya National Immunization Technical Advisory Group (KENITAG) that is in the process of formation. The main areas of focus are improving and sustaining the disease control gains achieved through improved routine and supplemental immunization coverage and increasing the range of vaccine preventable diseases covered for infants and the general population. The latest Kenya Demographic & Health Surveys (2008-09) show progressive improvement in the proportion of children fully immunized. The cMYP has detailed how these gains are to be sustained and improved.


There will however be risks in achieving the goals outlined in the cMYP due the transitional challenges that the country will invariably experience as it implements a radical new constitution which will, among other things, devolve governance of health service delivery from the current national level coordination to 47 new county governments. The new constitution should be fully implemented by 2012 and therefore rapid restructuring of national and regional levels of administration are expected in all government departments by then, including the Ministries of Health. This is a grey period and the Division of Vaccines & Immunization intends to mitigate any regression of gains achieved so far through close consultation with immunization stakeholders and dialogue with the health departments of County governments. The implementation of this cMYP will be relooked upon the election of County governments early next year, 2013 since they will be in charge of Health service delivery at this level. Kenya is committed to implement the cMYP 2011-15 through the dedication of health workers, community participation and support from partners in health to achieve the MDGs 4 & 5 targets. Community involvement and ownership of the EPI agenda is still our overall goal to guarantee success and sustainability of our programme.


1 BACKGROUND

Kenya is situated in East Africa; it borders Tanzania to the South, Uganda to the West, Ethiopia and Sudan to the North, Somalia to the Northeast, and the Indian Ocean to the Southeast. It has a surface area of 582, 646 square kilometres and approximately 80% is either arid or semi-arid while only 20% is arable. Following the promulgation of the new Constitution of Kenya in August 2010 the country is now administratively divided into 47 counties. Kenya’s projected population for the year 2011 is 41,822,715.

1.1 Health situation in Kenya

The Kenyan epidemiological profile indicates that disease burden is still high. A high disease burden is a barrier to economic growth - Most of sicknesses are caused by preventable conditions. Top five causes of outpatient morbidity namely Malaria, Diseases of the Respiratory System, Diseases of the Skin, diarrhoea, and accidents account for about 70percent of total causes of morbidity. Malaria contribute about a third of total morbidity. The leading causes of mortality are: Infectious and parasitic diseases (42 percent of total mortality in 2008) followed by Diseases of Respiratory System (11 percent), and Diseases of Circulatory System (7 percent).

HIV prevalence estimates vary widely, but the latest estimates from the 2008/09 Kenya Demographic and Health Survey (KDHS) place the prevalence rate at 6.3 percent, slightly lower than the previous estimate of 6.7 percent (KDHS 2003). Although this reduction is small in terms of number of cases as compared to the total population, effective prevention programmes are considered for keeping infection rates low in the future.

In the recent past, Government’s efforts and support of Development Partners have resulted in reversing the downward trend in health status indicators of the population observed in the 1990s. Remarkable achievements have been made in the reduction of Under Five Mortality from 115 per 1,000 live births in 2003 to 74 per 1,000 live births in 2008/9 and Infant Mortality from 77 per 1000 live births to 52 per 1000 live births in the same period. The proportion of children fully immunized against communicable diseases increased from 64percent in 2005/06 to 82 percent in 2011. Maternal mortality still remains high at 488 per 100,000 population.

Nutritional status of children has also not shown significant improvement over the years. An estimated 16 percent of children under-five years are underweight, 7 percent are wasted, and 35 percent are stunted.

Regional level health indicators show that North Eastern, Coast, Nyanza and Western Provinces have the worst infant and child mortality indicators. High poverty levels and inadequate environmental sanitation among other factors may be contributing to these differentials. .


Figure 1: Top causes of outpatient morbidity in Kenya The health sector will play its part in the attainment of the Vision goals. In this regard, the need for a robust health infrastructure; a financing mechanism that allows Kenyans, especially the poor to access affordable and quality services; an increased focus on preventive and promotional healthcare and the delinking of the Ministries of Health from service provision are identified as some of the key interventions that need to be implemented in the medium to long term period

Impact indicators are a good measure of trends in overall health of the population. The most commonly used impact indicators relate to the mortality indicators – Adult Mortality Rate (AMR), Maternal Mortality rate (MMR), Under-5 Mortality Rate (UMR), Infant Mortality Rate (IMR), Neonatal Mortality Rate (NMR) and other similar measures. Improvements in the mortality indicators suggest impact of interventions meant to improve the health of the population.

The trends in mortality impact indicators during the period 1993-2008 are shown in the figure below

Malaria31%

Disease of the Respiratory System

25%

Disease. of the Skin (Incl. Ulcers)

7%

Diarrheal Diseases5%

Pneumonia3%

Accidents (incl.. fractures, burns etc)

2%

Rheumatism, Joint pains

etc2%Eye Infection

2%

Urinary Tract Infections

1% Intestinal Worms

1%

All Other Diseases 21%


Figure 2: Trends in Health Impact indicators (1994-2008)

Source: Respective Demographic and Health Surveys

The general trend in impact indicators suggests a stagnation of the health situation during that period that is only appearing to improve during its last few years. Infant, and Under 5, and Mortality are starting to show improvements, while maternal and neonatal mortality have stagnated.

Data from the 2009 Demographic and Health Survey is also suggestive of improvements in Adult Mortality. A comparison of the rates from the 2008-09 KDHS and the 2003 KDHS indicates a decline in adult mortality for both women and men, but the patterns differ slightly.

Female adult mortality rates from the 2008-09 data are lower for all ages, except from age 35 upward, where the rates are nearly the same as those from the 2003 survey. Male adult mortality is lower for most of the age groups, except age groups 15-19 and 45-49.

1.2 Child health interventions in Kenya

Kenya's child health strategy includes a range of interventions in early childhood, neonatal health care, school health services and adolescent health. Integrated management of childhood illness (IMCI) for children less than five years of age was introduced in selected districts in the late nineties and expanded during the following decade.

NHSSP-II 2005-2010 specified the Kenya essential health package (KEPH). It is based on the life cycle approach. The key indicators for phase 1 (pregnancy, delivery and the newborn child) include BCG vaccination. Phase 2, early childhood, includes nine indicators on service access, notably IMCI, and coverage such as bed nets, breastfeeding, immunization coverage, vitamin A supplementation. Phase 3 concerns late childhood with community interventions focused on de-worming of children and school health programmes and phase is about adolescence and the access to youth friendly services.

1.3 Coverage trends for Immunization

Long term annual trends in immunization coverage are derived from facility reports and regular household surveys. The best estimate of DTP3 coverage during 1980-2009 is

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shown in Figure 3 below. DTP3 coverage reached a peak of over 90% in 1995, gradually declined to a low of just over 70% during 2002-2004 and climbed in recent years to 85% in 2008. The other vaccines - BCG and measles - show a similar pattern. DTP dropout rates, the proportion of children who receive the first dose but not the third, was well below 10% in 1993, but increased to 17% in 1998 and 19% in 2003. The KDHS 2008 however showed that the DPT 1-3 dropout rate had reduced to 10%.

Figure 3: Trends of DTP 3 in Kenya, 1980-2008

The health facility reports show that the proportion of districts that have reached at least 80% coverage of DTP3 increased during 2003-06 to a high of 64%, but that in 2007 and 2008 a large decline was observed. The decline during this period should be interpreted with a background of the socio-political instability that resulted to disruption of health services, dislocation of populations and withholding of donor support.


Figure 4: Proportion of districts with at least 80% DTP3 coverage among children 12-23 months.

The household surveys can provide further insight into what population groups are affected most by the changes in coverage over time. It is notable that KEPI has succeeded in reaching rural populations just as well as urban children and that this has remained unchanged since 1998. Both urban and rural children were equally affected by the declining trend until 2003 and the subsequent upturn 2003-2008. The situation by mother's level of education is different. There were large differences in DTP3 coverage by level of mother's education and especially children of mothers with no education has lower coverage and were affected more severely during the weaker performance period of the immunization programme. The 2008 KDHS however indicates that immunization coverage among children of mothers with no education increased more than for other children, reducing the gap.

Figure 5:DTP3 coverage trends by residence and by mother's level of education

Source: KDHS 1998-2008.

The provincial differences are shown based on data from the 1993 and 2008 KDHS. Overall, DTP3 coverage was the same in both years (86%). North Eastern Province was for the first

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time included in 2003. It is notable however that, even though DTP3 coverage is lower than in other provinces, there was a dramatic increase from 25% in 2003 to 57% in 2008. Four out of eight provinces had DPT3 coverage of over 85% both in1993 and 2008. Nairobi province has shown a declining trend of the same, while Nyanza and Western province hardly achieved coverage beyond 80%. The data from North eastern province is limited to ascertain coverage and trends.

The proportion of pregnant women who received one or two doses of tetanus toxoid was very close to antenatal care coverage and was 85% in 2003. In the KDHS 2008 it was computed that 72% of mothers had their last live birth protected from neonatal tetanus1

The KDHS shows that most of the pregnant women receive Tetanus toxoid vaccine during their first ANC visit as demonstrated by the comparable coverage for both interventions.

1.4 Health Sector Priorities

The Government of Kenya (GOK) is determined to improve both access and equity of essential health care services, and to ensure that the health sector plays its essential role in the realization of the Vision 2030 and the five year Medium Term Plans (MTPs). As a signatory of the Millennium Declaration with its internationally defined Millennium Development Goals (MDGs), Kenya has expressed its commitment to reach these targets by 2015. Kenya has incorporated these and other international goals into its national targets. These are further being translated into regional and district level targets as part of the MoH’s annual operational plan to inform and guide local priority setting and resource

1 Includes mothers with two injections during the pregnancy of the last live birth, or two or more injections (the last within 3 years of the

last live birth), or three or more injections (the last within 5 years of the last live birth), or four or more injections (the last within ten years of

the last live birth), or five or more injections prior to the last live birth

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Figure 6: DTP3 coverage among children 12-23 months by province


allocation. Specific outcomes to be achieved in the Vision 2030 represent the achievements of the targets by MOH, through the implementation of the annual operational plans.

Figure 7: Pillars of Kenya’s development framework – Vision 2030 Source: Kenya National Economic and Social Council. At national level, the Vision 2030 and the First Medium Term Plan 2008-2012, whose three pillars are economic, social and political aims at achieving a globally competitive and prosperous nation with a high quality of life. The above will be achieved through strengthening the institutions of governance; rehabilitating and expanding physical infrastructure; and investing in the poor. A key component of the Vision 2030 is the introduction of the Social Health Insurance in a phased approach to eventually achieve universal coverage of free health care to the Kenya Population.


2 HEALTH CARE DELIVERY SYSTEM IN KENYA

Kenya’s Ministries of Health (Ministry of Medical Services and Ministry of Public Health and Sanitation) offer health services through their public sector health facilities that account for 46% of the 6,761 health facilities in Kenya. FBO/NGO and the private for-profit sector ‘own’ the remaining 54%. However, all EPI services in 4100 Public/FBO/NGO/Private facilities are supported by the Division of Vaccines and Immunization (DVI). The major NGO/FBO health care providers include: AMREF, CHAK/NCCK (Christian Health Association of Kenya), KCS (Kenya Catholic Secretariat), and the Kenyan Aga Khan Foundation. FBOs/NGOs and Private for Profit health providers are key actors in contributing to the achievement of the current National Health Sector Strategic Plan (NHSSP II). The NHSSP II recognizes that ‘reversing the trends’ cannot be achieved by the government health sector alone.

2.1 External Policy Environment

The Kenya national health system is operating within the context of other international health initiatives. In this regard, achievement of the MDGs targets is of primary importance, especially MDG 4 for DVI. Other policy documents are the Global Immunization Vision and Strategies (GIVS) and the African Region EPI Strategic Plan for 2006-2009. The National Health Sector Strategic Plans (NHSSPs) are translated into annual activities that are aligned to the available resource envelope for a particular fiscal year. An AOP, therefore, defines the year’s priorities, targets, activities and resources, on the basis of the ideals, strategies and targets spelt out in a particular NHSSP as well as on the lessons learnt from the implementation of preceding AOP. This annual operational plan is the sixth in the series. The Second National Health Sector Strategic Plan (NHSSP II)2, whose end date has been extended from 2010 to 2012 for the following reasons, forms the basis for this AOP:

• To align health sector strategic planning cycle to the Government of Kenya’s strategic planning cycle

• The NHSSP II strategic priorities are in line with the Kenya Vision 2030 and the First Medium- Term Plan (MTP) for 2008-2012

• The economic down turn, the post election events and the associated reorganisation of the Government health services had a negative impact on the implementation of the Roadmap for Acceleration of Implementation of Interventions to Achieve the

Objectives of the NHSSP II,3 and as such the extension will provide an opportunity to ensure the implement the roadmap hence achieving the NHSSP II objectives.

2 Ministry of Health, Reversing the Trends-The second National Health Sector Strategic Plan for Kenya: NHSSP 11, 2005-

2010, September 2005. 3 Ministry of Health, Roadmap for Acceleration of Implementation of Interventions to Achieve the Objectives of the NHSSP II

,

December 2007.


The country is currently developing the third Kenya Health Sector Strategic Plan (KHSSP III) which has its goal, ‘accelerating attainment of health impact goals’ as defined in the Kenya Health Policy (2012-2030). The sector places its main emphasis on implementing interventions, and prioritizing investments relating to maternal and newborn health, as it is the major impact area for which progress was not attained in the previous strategic plan.

The Health Services objective for the Kenya Health Policy is to attain universal coverage with critical services that positively contribute to the realization of the overall policy goal. Six policy objectives, therefore, are defined, which address the current situation – each with specific strategies for focus to enable attaining of the policy objective. Objectives that have a clear link to the health MDGs and immunization, and that have a clear intent to strengthen the national health system are highlighted below:

• Eliminate communicable conditions: This is to be achieved through reducing the burden of communicable diseases, till they are not of major public health concern.

• Provide essential health care. These shall be medical services that are affordable, equitable, accessible and responsive to client needs.

• Minimize exposure to health risk factors. This aims at strengthening the health promoting interventions, which address risk factors to health, plus facilitating use of products and services that lead to healthy behavior in the population.

• Strengthen collaboration with other sectors. This aims to adopt a ‘Health in all Policies’ approach, which ensures the Health Sector interacts with and influences design implementation and monitoring processes in all health related sector actions.

2.2 Sector strategic framework, and documents

The sector has a comprehensive set of strategic documents guiding its actions. These are either primary guidance documents, or secondary guidance documents that represent a re-arrangement of information in the primary documents, based on expectations of different constituents. These different documents, and their relations, are highlighted below.

Table 1: Table Health Sector strategic documents

Area of guidance

Primary documents Secondary documents

Policy level Kenya Health Policy Framework

Program – specific policy guidelines

Strategic level National Health Sector Strategic Plan

Investment level

Joint Program of Work and Funding

National Health Strategic Plan Ministry strategic plans Department investment / strategic plans


Program – specific investment / strategic plans System – specific investment / strategic plans

Operational level

Annual Operational Plans

• Departmental AOP 6 plans

• Provincial AOP 6 plans

• Parastatal AOP 6 plans

AOP 6 consolidated plan

The sector results chain is defined around the primary documents. The secondary documents re-package the information in the primary documents, depending on the constituent needs.

2.2.1 Policy level documents

These define the long term direction the country is taking in health. The Kenya Health Policy Framework is the primary policy document for health in Kenya. This is being updated during this AOP 6, to cover the period 2011 – 2030, to provide the key policy directions for the health sector leading to attainment of the Vision 2030. Specific policy guidelines are developed, for key areas in the sector, but which are all linked to attainment of the policy imperatives of the KHPF.

2.2.2 Strategic level documents

These outline the Medium Term strategic direction for the health sector in the country. It is captured in the five strategic objectives of the National Health Sector Strategic Plan II. Originally intended to guide the sector up to 2010, its timeframe has been extended to 2012 (see proceeding section).

2.2.3 Investment level documents

These outline the investment priorities during the period of the sector strategic plan. The overall sector investment plan is the Joint Program of Work and Funding (JPWF), 2005 – 2010, around which all investments in the sector are aligned. It forms the basis for the sector partnership process, which is designed to align and coordinate efforts of the sector in attaining the respective priority investments. Most current sector documents are a re-packaging of the investment priorities in this JPWF

• The roadmap for acceleration of NHSSP II objectives: This is the way forward, arising from the Mid Term Review of the NHSSP II. It highlights the investment


priorities the sector needs to focus on, to accelerate movement towards the NHSSP II objectives.

• The Ministry Strategic Plans: These re-package the JPWF investment priorities, around the respective mandates of each Ministry, and provide more detail on implementation priorities

• The Health Strategic Plan: This brings together the investment priorities from the strategic plans of both Ministries into one document

• The departmental / division strategic plans: These re-package the JPWF investment priorities around the mandate of a given department, and provide more detail on the deliverables.

• The program investment plans (e.g. EPI MYP, Malaria strategy): These re-package the JPWF investment priorities around the mandate of a given program area, and provide more detail on the deliverables.

• The system investment plans (e.g. HRH strategic plan): These re-package the JPWF investment priorities around the mandate of a given system area, and provide more detail on the deliverables.

2.2.4 Operational level documents

These represent the guide for the activity priorities for different sector constituents. Each health facility or management unit in the sector has an annual operational plan (AOP). These are consolidated at each level, up to the single sector wide Annual Operational Plan 6 document.

The above results chain is comprehensive in structure, covering all the sector planning and monitoring needs. The only gap is in the timeline of the NHSSP II, which ends in 2010.

2.3 Sector targets and indicators

These remain the same as in the NHSSP II document. Overall impact sought is outlined in Annex 6.

2.4 Recap of sector strategic priorities

2.4.1 Recap of Vision 2030

Kenya Vision 2030 articulates the national development agenda for the country. The Vision specifies strategies for achieving the following economic, social and governance targets that are expected to transform Kenya from low income to a rapidly industrializing middle-income nation by the year 2030:

• Sustainable economic growth of 10% per year over the next 25 years.

• A just and cohesive society enjoying equitable social development in a clean and secure environment.


• An issue-based, people-centred, result-oriented and accountable democratic political system.

Kenya’s Vision 2030 for health is to provide equitable and affordable health care at the highest affordable standard to all citizens, involving (among other things) the restructuring of the health care delivery systems in order to shift the emphasis from curative to preventive and promotive health care. Improved access, equity, quality, capacity and institutional framework are the main focus areas that will be achieved through a devolution approach that will allocate funds and responsibility for delivery of health care to hospitals, health centres, dispensaries and communities

2.4.2 Recap of the First Medium-Term Plan, 2008–2012

The first MTP sets out the policies, reform agenda, projects and programmes that Kenya’s Grand Coalition Government is committed to implement during the period 2008–2012 in line with Vision 2030. The MTP health sector objectives are to:

1. Reduce under-five mortality from 120 to 33 per 1,000 live births;

2. Reduce the maternal mortality ratio (MMR) from 410 to 147 per 100,000 live births;

3. Increase the proportion of deliveries by skilled personnel from the current 42% to 90%;

4. Increase the proportion of immunized children below one year from 71% to 95%;

5. Reduce the number of cases of TB from 888 to 444 per 100,000 persons;

6. Reduce the proportion of in-patient malaria fatality to 3%; and

7. Reduce the national adult HIV prevalence rate to less than 2%.

The MTP flagship projects for health are rehabilitating health facilities, strengthening the Kenya Medical Supply Agency (KEMSA), fully implementing the Community Strategy, de-linking the health ministry’s from service delivery, building the human resource capacity and developing equitable financing mechanisms.

2.4.3 Recap of NHSSP II 2005–2012

NHSSP II outlines the health sector strategies aimed at achieving the national development priorities and the Millennium Development Goals (MDGs). NHSSP II has as its overall goal is to reduce inequalities in health care services and reverse the downward trend in health-related outcome indicators. Five strategic objectives were set for the realization of this goal:

� Equitable access to health services increased.

� The quality and responsiveness of services in the sector improved.


� The efficiency and effectiveness of service delivery improved.

� The fostering of partnerships enhanced.

� The financing of the health sector improved.

The main innovations of NHSSP II in terms of service delivery are the definition of the Kenya Essential Package for Health (KEPH)4 and the re-definition of service delivery levels – most particularly the inclusion of level 1 (community level) services as part of the service delivery units. In order to deliver the essential health services effectively, core support systems to be strengthened are also articulated.

4 Ministry of Health, Reversing the Trends: The Second National Health Sector Strategic Plan of Kenya – The Kenya Essential

Package for Health, July 2007.


3 IMMUNIZATION PROGRAMME IN KENYA

The immunization system components include service delivery, vaccine supply, quality,

logistics, disease surveillance and advocacy, communication and social mobilization.

3.1 Service Delivery

In the next five years, the programme will endeavour to sustain and improve on the gains made over the years by providing quality immunization services. In Kenya, primarily most of immunizations take place in fixed posts and the programme will endeavour to re-energise the outreach strategy within the RED strategy framework and sustain it. In addition SIAs will be implemented periodically. .

3.2 Vaccine Supply, Quality and Logistics

The EPI programme will ensure that adequate vaccines bundled with injection materials are procured through WHO/UNICEF approved mechanisms. The Child Health ICC will advocate for the adequate and timely release of funds, procurement of vaccines and other logistics to be prioritised to avoid disruption of services. The current storage capacities for both vaccines and dry store materials at central and regional vaccine stores will be expanded in tandem with the growing population and range of vaccines. There is reinforcement of our cold chain capacity ongoing through support from the Japanese government in Central Vaccine Store-Kitengela, Nairobi and six other regional depots to be ready for hand over by Mid next year 2013.

The cold chain inventory showed that the Central Vaccine stores has adequate capacity to accommodate the current vaccine schedule and rotavirus vaccine up to the year 2015, after which capacity will be strained.

The regional stores also have adequate capacity and will be able to accommodate PCV 10 and Rotavirus for the foreseeable future. The regional vaccine stores are currently operating at approximately 30% capacity.

Deficiencies at other level of the cold chain were identified at district and facilities level and these issues are being addressed with the provision of new equipment and increasing the number of fixed facilities offering immunizations.

Solar energy was identified as the most abundant and underutilized source of energy. The Government of Kenya is currently in the process of acquiring over 500 solar chill refrigerators which are solar powered refrigerators that are directly powered by solar


without an external battery. These refrigerators will reduce the energy cost, lower maintenance cost and reduce carbon foot print of maintaining the cold chain.

COLDCHAIN CAPACITY AT CENTRAL VACCINE STORE AND REGIONAL DEPOTS

Figure 8: Cold Chain capacity at central vaccine store

Figure 9: Cold Chain capacity at regional depots

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

2011 2012 2013

National vaccine stores forecast 2011- 2013

Capacity

Requirements

0

5000

10000

15000

20000

25000

Regional Store Capacity and requirements

Capacity

Requirement 2011

Requirement 2012

Requirement 2013


DVI internal quality assurance mechanisms will in-turn ensure vaccine quality is maintained up to the point of utilization. .

A computerised stock management system is in place at the regional vaccine store rooms so as to improve management of vaccines and injection materials and is being rolled out to the regional stores with assistance from Clinton Health Access Initiative (CHAI).

At district and health centre levels, trainings will be conducted to improve stock keeping. Adherence to vaccine management guidelines and target settings will be monitored during the period. Transport availability for distribution of the programmes critical logistics will be improved at all levels through procurement of appropriate types of transport during the plan period. This will be accompanied with resources for maintenance and other operational costs of the vehicles. In addition a number of cold-chain equipments will be procured to expand our total cold-chain capacity. The programme will therefore advocate for adequate resources to achieve this obligation and also explore other cost effective options for logistics management.

Injection safety and waste management will be strengthened through ensuring continued use of AD syringes in both routine and supplemental immunization services and proper disposal of injection materials. National Health Care Waste Management Policy will guide the managements of Immunization waste. Health workers will from time to time receive training on safe injection and waste management practices. Since health care waste management has to be tackled in a broader perspective, the EPI will compliment efforts made by the MOPHS and other stakeholders by providing support for the construction of incinerators to cover the remaining District Hospitals to achieve 100% coverage during the planned period.

3.3 Disease Surveillance

The division of disease surveillance and response (DDSR) is responsible for disease surveillance and response activities, but DVI will liaise closely with DDSR for all vaccine preventable diseases.

Vaccine preventable disease surveillance data (Polio, measles, PBM and MNT) will be monitored so as to address gaps in immunization coverage in a timely manner as appropriate. PBM, Rota virus surveillance will be used to inform the introduction of rota virus vaccine and meningococcal vaccine. In this multiyear plan, we hope to maintain or improve the tempo of detection and notification of AFP, measles, and NNT at current levels efficiently.

3.4 Advocacy, social Mobilization and Communication

Advocacy, social mobilization and communication are very crucial in EPI services. Through the Child Health ICC and the health SWAp, the programme will lobby for more resources


for effective implementation of the planned activities. Of priority, will be the development and dissemination of the EPI communication plan informed by the KAP survey. The advocacy plan will be aligned to the National Health Promotion Policy. As part of the dissemination, health workers will be trained on the new guidelines. Advocacy meetings will be conducted with District Health Management Teams (DHMTs) and District Health Stakeholders for more EPI specific resource mobilization. Key EPI messages will be developed and disseminated through print media and electronic media both nationally and at local levels where this capacity is available. Other channels such as drama and community meetings will be encouraged and strengthened, spearheaded by the CORPs in conjunction with their respective CHEWs. The quarterly DVI newsletter will continue to be published and distributed to all health facilities and pre-service health institutions. The communication plan is finalized and will be rolled before the end of this year, 2012.

DIRECTOR FOR PUBLIC HEALTH AND SANITATION

HEAD:

DEPARTMENT OF FAMILY HEALTH

HEAD: DIVISION OF VACCINES AND IMMUNIZATION

POLICY DIRECTION, ADVOCACY, TRAINING &

MONITORING AND EVALUATION

ADVOCACY TRAINING DATA

COMMODITY SECURITY & QUALITY CONTROL

CENTRAL VACCINE STORE

GENERAL ADMINISTRATION

SUPPORT UNIT

Figure 10: Organogram of Division of Vaccines and Immunization


3.5 Goal of routine Immunization

The goal of the Division of Vaccine and Immunization is to reduce morbidity, mortality and

disability due to life threatening infections due to vaccine preventable diseases.

The Government of Kenya provides vaccines for the vaccine preventable diseases free of

charge through DVI. During the period of this plan, the following diseases have been

targeted: Tuberculosis, poliomyelitis, diphtheria, pertusis, tetanus, hepatitis B,

Haemophilus influenza type b, measles, yellow fever and pneumococcal disease. Rota virus

vaccine is planned for introduction in 2013 subject to availability of GAVI support as the

Government has already expressed intent of introducing this vaccine to GAVI.

3.6 Immunization Schedule for Kenya

Kenya has been expanding its package of immunization in line with advances in technology

in development of vaccines. The table below is a summary of Kenya’s immunization

schedule:

Table 2: Current Routine Vaccination Schedule for Children under 1 year

Vaccine

Ages of administration of routine immunization services

Indicate by an “x” if given in:

Comments Entire

country

Only in part of

the country

BCG At birth X

OPV At birth, 6wk, 10wk and 14wk X SIAs planned for 2011

DPT-HepB-Hib

6wk, 10wk and 14wk X

Pneumococcal vaccine (PCV 10)

6wk, 10wk and 14wk X To be introduced in January 2011

Measles 9 months X Measles SIA planned for 9 to 59 months old in 2012 and 2015

Yellow Fever 9 months X Given in four districts ( Baringo, Keiyo,


Koibatek and Marakwet) at high risk of yellow fever disease. Follow up SIAs planned for 2012

TT Pregnant women, WCBA and School aged children 7to14years

X Given in pregnancy under the 5TT schedule.

SIAs in high risk districts targeting WCBA in 2011

Vitamin A 6m,12m,18m,24m,30m,36m,42m,48m,54m and 60m. Less 6 weeks Postpartum mothers.

X To be integrated with measles/OPV SIAs

Unlike other antigens, Yellow fever vaccine is not administered throughout the country, but

in only four districts that are high risk of yellow fever, whereas additional strategies are

used for TT also in high risk districts. The additional strategies for TT include SIAs for

women of child bearing age (WCBA) districts and School-Based TT immunization activities.


4 IMMUNIZATION SYSTEM COMPONENTS

The immunization system components include service delivery, vaccine supply, quality, logistics, disease surveillance and advocacy, communication and social mobilization.

4.1 Service Delivery

In the next five years, the programme will endeavour to sustain and improve on the gains

made over the years by providing quality immunization services. In Kenya, primarily most

of immunizations take place in fixed posts and the programme will endeavour to re-

energise the outreach strategy within the RED strategy framework and sustain it. In

addition SIAs will be implemented periodically. .

4.2 Vaccine Supply, Quality and Logistics

The EPI programme will ensure that adequate vaccines bundled with injection materials

are procured through WHO/UNICEF approved mechanisms. The Child Health ICC will

advocate for the adequate and timely release of funds, procurement of vaccines and other

logistics to be prioritised to avoid disruption of services. The current storage capacities for

both vaccines and dry store materials at central and regional vaccine stores will be

expanded in tandem with the growing population and range of vaccines.

DVI internal quality assurance mechanisms will in-turn ascertain vaccine quality is

maintained to the point of utilization. AEFI surveillance will be improved through

production of guidelines, adequate tools and specific AEFI training.

Introduction of a computerised stock management system is planned for the regional

vaccine store rooms so as to improve management of vaccines and injection materials. This

will require procurement of computers and accessories. Ongoing projects, such as the

construction of the new DVI headquarters, additional national and regional stores are

expected to be completed in the duration of this cMYP through the support of JICA.


At district and health centre levels, trainings will be conducted to improve stock keeping.

Adherence to vaccine management guidelines and target settings will be monitored during

the period. Transport availability for distribution of the programmes critical logistics will

be improved at all levels through procurement of appropriate types of transport during the

plan period. This will be accompanied with resources for maintenance and other

operational costs of the vehicles. In addition a number of cold-chain equipments will be

procured to expand our total cold-chain capacity. The programme will therefore advocate

for adequate resources to achieve this obligation and also explore other cost effective

options for logistics management.

Injection safety and waste management will be strengthened through ensuring continued

use of AD syringes in both routine and supplemental immunization services and proper

disposal of injection materials. National Health Care Waste Management Policy will guide

the managements of Immunization waste. Health workers will from time to time receive

training on safe injection and waste management practices. Since health care waste

management has to be tackled in a broader perspective, the EPI will compliment efforts

made by the MOPHS and other stakeholders by providing support for the construction of

incinerators to cover the remaining District Hospitals to achieve 100% coverage during the

planned period.

4.3 Disease Surveillance

The division of disease surveillance and response (DDSR) is responsible for disease

surveillance and response activities, but DVI will liaise closely with DDSR for all vaccine

preventable diseases.

Vaccine preventable disease surveillance data (Polio, measles, PBM and MNT) will be

monitored so as to address gaps in immunization coverage in a timely manner as

appropriate. PBM, Rota virus surveillance will be used to inform the introduction of rota

virus vaccine and meningococcal vaccine.


In this multiyear plan, we hope to maintain or improve the tempo of detection and

notification of AFP, measles, and NNT at current levels efficiently.

4.4 Advocacy, social Mobilization and Communication

Advocacy, social mobilization and communication are very crucial in EPI services. Through

the Child Health ICC and the health SWAp, the programme will lobby for more resources

for effective implementation of the planned activities. Of priority, will be the development

and dissemination of the EPI communication plan informed by the KAP survey. The

advocacy plan will be aligned to the National Health Promotion Policy. As part of the

dissemination, health workers will be trained on the new guidelines. Advocacy meetings

will be conducted with District Health Management Teams (DHMTs) and District Health

Stakeholders for more EPI specific resource mobilization. Key EPI messages will be

developed and disseminated through print media and electronic media both nationally and

at local levels where this capacity is available. Other channels such as drama and

community meetings will be encouraged and strengthened, spearheaded by the CORPs in

conjunction with their respective CHEWs. The quarterly DVI newsletter will continue to be

published and distributed to all health facilities and pre-service health institutions.


5 SITUATION ANALYSIS

This chapter presents the performance of the immunization system components focusing on the status, gaps and challenges over the last five to ten years.

5.1 Routine Immunization Performance, Gaps and Challenges

Since the inception of Kenya Expanded Programme on Immunization in the 1980s,

immunization coverage increases albeit slowly till the early 1990s. In the 1990s, political

and economic changes negatively impacted the programme. Coupled with donor

withdrawal, these changes led to rapid decline in immunization coverage till late 1990s

when the government committed to fully procure all EPI vaccines. This led to progressive

increase in coverage with fully immunized child coverage of >80% in 2011 (fig 9)

Figure 11: Trends of immunization performance for selected indicators, 1992-2009, Kenya

Despite these gains, the programme has experienced challenges in the recent past that have

caused the coverage to either plateau or decline. These challenges include:

0

20

40

60

80

100

120

1992 1993 1994 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Measles BCG DPT/Penta 3 FIC


• Inaccessibility of immunization services because of distant health facilities

especially among the nomadic communities, poor health seeking behaviour of

caregivers due to socio-cultural issues and insecurity in some parts of the country.

• Inadequate or late disbursement of finances for procurement and operations.

• Vaccine stock outs at the service delivery points due to delay in vaccine distribution

from national to regional levels or inadequate planning by the districts.

• Limited community participation in planning of health services

• Shortage of staff to man the health facilities due to shortage and mal-distribution of

existing health workers

• Poor motivation of health workers due to lack of supervision, requisite skills,

knowledge and low morale.

• Lack of quality support supervision at all levels compounded by lack of adequate

transport to facilitate movement. Support supervision has been infrequent, poorly

coordinated, unplanned and not evidence-driven

• Increase in the number of districts resulting to inadequate finances and resources

for programmatic management including purchase and maintenance of cold chain

equipment.

• Lack of communication strategy and plan to create demand for immunization

services due to lack of necessary expertise and social profiling.

• Inadequate human resources at service delivery points to provide immunization

services.

The table below summarizes the situation analysis of EPI progress of each system

component.


Table 3: Situational analysis of routine EPI by system components based on previous years' data (2007-2009)

System components

Suggested indicators

(National∗∗∗∗ )

2007

2008 2009 2010 2011

Routine Coverage

National coverage of fully immunized child (FIC)

77 71 69 81 82

National

DPT3/Hib/HepB(Penta3)

coverage

81 72 75 83 88

% of districts with > 80%

coverage(Penta 3)

57 56 58 53 63

National DPT1-DPT3

dropout rate

9 14.2 6.3 10 7.7

Percentage of districts

with dropout rate DTP1-

DTP3>10%

34.6 28.3 34 46 26.8

New vaccines National HepB3 coverage NA NA NA NA NA

Routine Surveillance

% of surveillance reports

received at national level

from districts compared

to number of reports

expected

No data No data No data

92 92

Quality of surveillance

data sufficient? (Y/N)

Y Y Y Y Y

Cold chain/Logistics


with adequate number of

functional cold chain

equipment

65 70 72 61 65

Immunization safety and Waste Management


supplied with adequate

(equal or more) number

of AD syringes for all

routine immunizations

100 100 100 100 100


supplied with safety boxes

100 100 100 100 100


with proper sharps waste

management systems

No Data No Data No Data

No Data No Data

Vaccine supply Was there a stock-out at

national level during last

year? (Y/N)

Y Y Y N Y

If yes, specify duration in 3 1/1 3*/1/ NA 1week

∗ It is useful to include the data source for each data set. GRF 2011


months 1

If yes, specify which

antigen(s).

BCG BCG/OPV

BCG, OPV, Measles

NA TT

Vaccine wastage

monitoring at national

level for all vaccines?

(Y/N)

N N N N N

Communication

Availability of a plan?

(Y/N)

N N N N N


which have developed EPI

communication plans

0 0 0 0 0

Percentage of caretakers

of children < 1yr

understanding the

importance of routine

immunization.

No data No data No data No data

Financial sustainability

What percentage of total

routine vaccine spending

was financed using

Government

funds?(including loans

and excluding external

public financing)

100 100 100 17.3 10.3

Management planning

Are a series of district

indicators collected

regularly at national

level?(Y/N)

N N N Y Y

Percentage of all districts

with micro plans.

No data No data No data

67 100

Research/studies

Number of vaccine related

studies conducted/being

conducted

1-PCV 7 trial

1-PCV 7

1-Rotateq

PCV-10, Rotateq, Malaria vaccine, Hiv vaccine studies

3- Malaria vaccine, Yellow Fever, VVM Vs Vaccine potency study

NRA Number of functions

conducted-registration of

vaccines to determine

efficacy

0 0 0 2 02 0

National ICC Number of meetings held

last year-withy EPI

4 4 4 4 4


agenda discussed

Human Resources availability

Percentage of sanctioned

posts of vaccinators filled-

no vaccinator cadres in

Kenya

N/A N/A N/A N/A N/A

Percentage of health

facilities with at least 1

health worker

60 90 100

Percentage of health

workers time available for

routine EPI

40 40 40 40 40

Number of health workers

/ 10.000 population

11 17

Transport / Mobility


with a sufficient number

of supervisory/EPI field

activity

vehicles/motorbikes/bicy

cles in working condition

100 80 70 60 50

Waste Management

Availability of a waste

management plan

Y Y Y Y Y

Linking to other Health Interventions

Were immunization

services systematically

linked with delivery of

other interventions

(Malaria, Nutrition, Child

health etc)?

Y Y Y Y Y

Programme Efficiency

Timeliness of

disbursement of funds to

district and service

delivery level

N0 No No No No

\

School

Immunizatio

n Activities

Age Antigens provided

Coverage 2007

Coverage 2008

Coverage

2009

Coverage 2010

None

7-15 YRS

TT, Abendazole 90 %** None None

**school based TT campaign in Coast Province in 2006/2007

5.2 Polio eradication

After 22 years of being polio free, Kenya unfortunately confirmed wild polio outbreak in

Garissa district in North Eastern province bordering Somalia in October 2006. This was

quickly contained. Another wild polio outbreak was confirmed in Turkana districts, Rift


Valley in January 2009 following importation of wild polio virus from Southern Sudan. A

total of 19 cases were reported. This followed a previous outbreak of wild polio in North

Eastern province in 2006 imported from Somalia. Kenya followed the recommendations of

the Advisory committee on Polio Eradication and responded to the outbreaks that were

contained at both times.

Kenya has attained the national AFP surveillance indicators although sub-optimal

performances have been reported in some regions. The immunity of the population has

been low due to low immunization coverage of OPV3 which has been declining in the last

three years (2007-2009) as shown in the table below hence putting Kenya at risk of wild

polio importation from the neighbouring countries. This poor performance has resulted

from challenges facing the immunization programme as discussed under routine

immunization.

Table 4: Situational analysis of polio eradication 2011

System components


National∗∗∗∗

2007

2008 2009 2010 2011

Polio OPV3 coverage 76 74 72 83 88

Non polio AFP rate per

100,000 children under 15

yrs. of age

2.56 2.23 3.2 2.83 3.29

Extent: NID/SNID

No. of rounds

Coverage range

SNID

2

92

SNID

8

SNID

2

107

SNID

6

86-92

5.3 Accelerated disease control

The immunization coverage of measles and maternal and neonatal tetanus has been

declining for the last 3 years (2007-2009) as shown in table 5. Measles outbreaks have

been reported in various parts of Kenya and 1218 cases were reported in 2009. See table 5

below. So far the about 94 cases of measles (29 lab confirmed, 57 epi-linked and 8

∗ It is useful to include the data source for each data set. JRF IM


compatible) have been reported from Jan to Jun 2010, however more than 90% of the cases

are above 15years of age (outside the EPI target group). The reasons for the downward

trend in the immunization coverage are discussed in detail under routine immunization.

Table 5: Situational analysis by accelerated disease control initiatives, Based on previous years' data (2007-2009)

System components


National

∗∗∗∗

2007

2008 2009 2010 2011

MNT TT2+ coverage 78 71 60 72 76

Number of districts

reporting > 1case per 1,000

live births

NONE NONE NONE NONE NONE

Was there an SIA? (Y/N) N Y N N N

Measles Measles coverage 80 76 74 86 87

No. of outbreaks reported

(Cases)

262 1280 1218 1271 3096

Extent: NID/SNID

Age group

Coverage( under 1 yr to 15+)

NID

9-59 mths

83

N N/A

∗ It is useful to include the data source for each data set. JRF IM


6 PRIORITIES, OBJECTIVES AND MILESTONES FOR EPI

Based on the situational analysis, the priority activities for immunization programme for

the planned period are the following:

i) Polio eradication

ii) Accelerated disease control

iii) Improving performance of routine Immunization

iv) Supplemental Immunization

v) Improving financial flows

vi) Creating demand of immunization services through evidence-driven

advocacy

vii) Improving the capacity of health workers

The table below gives in detail the priority areas, objectives and the milestones. Table 6:National objectives and milestones, AFR regional and global goals

National priorities

NIP Objectives NIP Milestones

AFRO Regional goals

Order of Priority

Penta 3 To attain immunization coverage (Penta 3) of 90% nationally with at least 80% coverage in every district by 2015

2011: 88% National and at least 37% in every district 2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80%

By 2010 all countries will have routine immunization coverage of 90% nationally with at least 80% coverage in every district.

1

Fully Immunized Child

To attain fully immunized child national coverage of 90% by 2015

2011: 82% (Achieved) 2012: 84% 2013: 86% 2014: 88% 2015: 90%

1

Polio To attain immunization

2011: 88% National and at least 35% in every district

. 1


National priorities


AFRO Regional goals

Order of Priority

coverage (OPV3) of 90% nationally with at least 80% coverage in every district by 2015

2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80%

Measles To attain measles immunization coverage of 90% nationally with at least 80% coverage in every district by 2015 To introduce Measles Second Dose (MSD)by 2013

2011: 87% National and at least 34% in every district 2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80% 2013-MSD II rollout

1

TT2 + To attain TT2+ immunization coverage among pregnant women of 80% nationally with at least 80% coverage in every district by 2015

2011: 76% 2012: 77% 2013: 78% 2014: 79% 2015: 80%

3

Yellow Fever To attain 80% coverage in the high risk districts by 2015

2011: 56% 2012: 68% 2013: 72% 2014: 76% 2015: 80%

5

Vitamin A Supplementation

To attain 80% coverage (2 doses ) of Vitamin A by 2015

2011: 33% 2012: 50% 2013: 55% 2014: 60% 2015: 80%

1

Pneumococcal

To attain immunization coverage (PCV-10) of 90% nationally with at least 80% coverage in every district by 2015

2011: 85% National and at least 37% in every district 2012: 90% /60% 2013: 90% /67% 2014: 90% /74% 2015: 90% /80%

1


National priorities


AFRO Regional goals

Order of Priority

Rota To introduce rotavirus vaccine by 2013

2011: Proposal developed and conditional approval given by GAVI board. 2012: Approval with clarifications 2013: Introduction of Rotavirus vaccine 2014: Post introduction evaluation

8

HPV Vaccine To set up HPV demonstration project in Kenya by the year 2013

Demonstration project

Immunization Safety

To sustain 100% supply of safe injection supplies and practices by 2015

All districts are supplied with adequate quantities of AD syringes and safety boxes during planning period (2011-2015)

20

Waste Management

All districts to have and implement a waste management plan by 2015

2011: 50% of districts with incinerators 2012: 70% 2013: 80% 2014: 90% 2015: 100%

6

Surveillance To attain and sustain core indicators for AFP and Measles by 2015 To attain MNT elimination.

2011-2015: Non Polio AFP rate: 4 2011-2015: Non measles febrile illness: 3.3/10,000 2012: NNT incidence in 80% districts: <1/1000 live 2013: NNT incidence in 90% districts: <1/1000 live 2014: NNT incidence in 100% districts: <1/1000 live births

4


National priorities


AFRO Regional goals

Order of Priority

To attain PBM and Rotavirus indicators by 2015 Maintain surveillance reporting rates (timeliness and completeness) above 90% in all districts

2013-2014: Proposal development for surveillance of intussusception. 2013: 100% timely reporting for PBM and Rota surveillance 2014: Data on intussusceptions rate available 2011-2015: Maintain reporting rate (timeliness and completeness) above 90% in all districts

Vaccine Supply

To attain 100% of districts with no stock outs of vaccines at the district stores by 2013

2011-2015: To have National level vaccine stocks within min-max zone 2013: 80% of districts with no stock outs 2014- 2015: 100% of districts with no stock outs

1

Cold Chain / Logistics

To increase the number of districts with adequate cold chain capacity at the district stores from 61% to 85% by 2015

2011: 65% of districts have adequate cold chain capacity 2012: 70% 2013: 75% 2014: 80% 2015: 85%

3

Advocacy and Communications

To develop and implement a communication plan for immunization in all districts by 2013

2012: National Communication plan for immunization Finalized 2013-2015: All districts adapt & implement communication plan for immunization

7

Management and Planning

To increase the proportion of districts with immunization

2012: 80% of districts 2013-2015: 100% of districts have micro-plans that are

2


National priorities


AFRO Regional goals

Order of Priority

specific micro-plans to 100% by 2015

implemented and tracked

Programme Efficiency

To increase and maintain timelines of disbursement of funds to districts from 0% to 100% by 2015

2011: 30% Timeliness of disbursement 2012: 50% 2013: 60% 2014: 70% 2015: 100%

2

Financial Sustainability

To increase and ring fence financial allocation from 550million to 830million for immunisation activities by 2015

2011: Co-financing for pneumo factored in 2011/2012 budget and subsequent years 2011: Financial allocation for purchase of traditional vaccines and injection material increased from Kshs. 400million to Kshs.670million 2011: Financial allocation for operations at sub-national level increased from Kshs. 40million to Kshs. 160million 2012: Co-financing for rota virus factored in annual budget of 2012/2013 2013: Availability of sustainability plan for pentavalent, pneumococcal and rota vaccine beyond 2015 2014: Financial allocation for immunization increased in tandem with population growth

Human Resources Management

To increase proportion of public health facilities with at least one nurse from 90% to 100% by

2012-2015: Identify critical HR gaps for immunization and share the with HR department and all partners 2012-2015: Recruitment and

10


National priorities


AFRO Regional goals

Order of Priority

2015.

Re-deployment of additional health workers

Transport To improve service delivery of immunization services through provision of at least one vehicle per district

2011: Inventory of vehicles done 2012: 70% of districts with vehicle 2013: 80% of districts with vehicle 2014: 90% 2015: 100%

Training and capacity building

To improve the capacity (knowledge and skills in EPI) of health workers offering immunization services on EPI in all health facilities in the country by 2015

2011: Training needs assessment conducted and training materials developed 2012 pre-service curricula on immunization revised 2012: 50% of eligible health workers capacitated 2013: 70% of eligible health workers capacitated 2014: 90% of eligible health workers capacitated 2015: All health workers capacitated

Research / Studies

To determine the impact of vaccination on the burden of selected targeted VPDs 2015

2011: Review baseline data on burden of pneumococcal disease and Rota virus 2012-2015: 1 Operational Research supported annually 2012-2015: Impact studies of the introduction of PCV10 and Rota virus vaccine.

National Regulatory Authority

To establish a mini lab for vaccine quality assurance by 2012

2011: Secure financial resources for establishment of Mini Lab 2012-2015: Equip and operationalize the mini lab and link up with NQCL 2013-Report on vaccine potency


National priorities


AFRO Regional goals

Order of Priority

Linking to Other Health Interventions

To integrate EPI with implementation of high impact child survival interventions to reach all districts by 2015

2012: identify areas for integration at National levels. 2013-2015: Availability of integrated plans at district and facility level that prioritize high impact interventions


7 IMPLEMENTATION PLAN

The focus of the implementation plan is on the core areas that will improve the immunization coverage and control of vaccine preventable diseases. The plan focuses on the following areas:

• Service delivery and programme management

• Advocacy for immunization

• Surveillance

• Vaccine supply, quality and logistics Under service delivery the focus will be on the roll-out of all components of RED strategy and monitor its implementation. Other issues to be implemented are integration as best practices and data management. In order to create demand for immunization services, we will develop and implement an advocacy and communication plan at all levels. Surveillance will be strengthened through improvement of capacity of health workers, enhanced supervisory capacity, improving laboratory capacity in diagnosis and strengthening use of data for action. Vaccine supplies, quality and logistics will be improved through guaranteed availability of quality vaccines and injection materials, expansion of the cold capacity, improved efficiency of the supply chain and vaccine distribution, improved vaccine handling and storage and effective waste management. The tables 7, 8, 9 and 10 below provide detailed strategies and activities to achieve the objective. Table 7: Service delivery and Programme Management


National Objective

Strategy Key Activities

To attain immunization coverage (FIC, Penta 3, OPV3, Measles and PCV 10) of 90% nationally with 80% of the districts attain 90% by 2015

Roll out of RED /DQS in districts that contribute 80% of un-vaccinated children

Conduct monthly defaulter tracing

Institutionalize outreach in priority areas

Conduct quarterly review meetings at national, provincial and district levels

Hold periodic community stakeholders meetings at the health facility

Conduct monthly data analysis and dissemination meetings at each level Conduct quarterly data verification, validation and written feedback

National child health days [Malezi bora]

Carry out periodic intensification of routine immunization

To attain TT2+ immunization coverage of 80% nationally with at least 80% coverage in every district by 2015

Implement the 5 TT schedule targeting WCBA within and outside pregnancy using routine and high risk approach SIAs


Implement SIAs for WCBA in high risk areas

TT validation

To attain 80% coverage (at least 2 doses) of Vitamin A by 2015 in children up to1 year

Acceleration of RED Institutionalize outreach in priority areas



Hold quarterly community stakeholders meetings

Conduct monthly data analysis and dissemination meetings at each level

Conduct quarterly data verification, validation and written feedback

Using Malezi bora Carry out periodic intensification of routine immunization

To increase immunization coverage of yellow fever from 13% to 90% in the high risk districts by 2015

Roll out of RED/DQS





Conduct monthly data analysis and


dissemination meetings at each level


Follow up immunization of yellow fever

To conduct follow up immunization campaign of high risk population

To introduce measles second dose by 2017

Planning for measles second dose introduction

Constitution and launch of the national steering committee, technical coordinating committee and sub-committees

Development of district micro plans

Resource mobilization

Develop a budget and mobilize resources for introduction of measles second dose

Lobbying for sustained annual financial increment for co-financing commitment for vaccine procurement

Source for technical and financial assistance from partners

Commodities, supplies and logistics

Conduct EVMA

Develop a cold chain replacement and expansion plan

Distribution of vaccines and other supplies to all levels

Build human resource capacity

Development of training materials

Training of health workers

Advocacy and communication

Develop, print and distribute communication materials Conduct stakeholders sensitization meetings at all levels

National, provincial an district launch

To introduce ten valent pneumococcal conjugate vaccine (PCV-10) by 2011

Planning for pneumococcal introduction




Develop a budget and mobilize resources for introduction of PCV-10



Commodities, supplies and

Conduct EVMA

Develop a cold chain replacement and


logistics expansion plan






Develop, print and distribute communication materials

Conduct stakeholders sensitization meetings at all levels National, provincial an district launch

To monitor adverse events and the impact of introduction of PCV10 in Kenya by 2014

Monitoring and evaluation

Conduct PVC10 impact studies

Conduct AEFI studies

To introduce rotavirus vaccine by 2013

Planning for Rota virus vaccine introduction




Develop a budget and mobilize resources for introduction of rota virus vaccine



Commodities, supplies and logistics

Develop a cold chain replacement and expansion plan Distribution of vaccines and other supplies to all levels






Conduct stakeholders sensitization meetings at all levels

National, provincial and district launch

Monitoring and evaluation

Revise, print and distribute all data collection tools


Monthly review of performance of rotavirus vaccine

Conduct AEFI study including intussusception

To introduce HPV Vaccine by 2015

Set up of demonstration project sites

Development and submission of proposal to GAVI

Set up sites

Document lessons from the study

Plan for national rollout of HPV

To prevent outbreaks of vaccine preventable diseases targeted for eradication, elimination and control by 2015

Supplemental immunization activities

Conduct measles follow up SIA

Conduct preventive polio SIAs in high risk districts Conduct TT SIAs in high risk districts

Determine burden of MNT and prioritize districts for intervention

Conduct risk assessment for MNT

Carry out MNT validation exercise

To increase the proportion of districts with immunization specific micro-plans to 100% by 2012

Dissemination of cMYP

Seek approval from child ICC and endorsement from HSCC

Print and distribute the plan to all stakeholders

Carry out stakeholders dissemination meeting

Hold monthly immunization technical working group meeting

Develop annual operation plan from cMYP

Develop district micro-plans

Annual update of the cMYP

Monitoring & evaluation of implementation of cMYP

Annual, mid-term and end term evaluation

To increase financial allocation for immunization from Kshs 550million to

Evidence driven high level advocacy

Prepare an economic evaluation brief on immunization

Develop a costing model for immunization activities

Prepare a resource mobilization information


Kshs830million and ring fence financial allocation for immunisation activities by 2015

package

Conduct a meeting with high level stakeholders

Sustainability plan for Penta/pneumo and other new vaccines

Fostering partnership

Broaden ICC membership to include Ministry of finance etc

Conduct joint planning and coordination meetings Conduct joint review of performance

Resource mobilization at sub-national levels

Mapping of immunization stakeholders and potential funding agencies.

Lobby for increased resources for immunization from local stakeholders

To increase timeliness of disbursement of funds from 0% to 100% by 2015

Advocacy

Conduct regular consultative meeting with finance and accounts

To increase proportion of health facilities with at least one nurse from 60% to 100% by 2015.

HR gap analysis Conduct immunization HR gap assessment

Disseminate the HR gap analysis report to all stakeholders

Advocacy Lobby deployment of HR to critical areas of need

Lobby for recruitment of critical HR

To improve capacity of health workers on immunization in 80% of all health facilities in every district by 2013

Training of health workers on immunization

Carry out training needs assessment

Revise immunization training materials

Carry out phased training incorporating the RED/DQS approach targeting all health workers involved in immunization, especially newly recruited staff

Review pre-service training curriculum of middle level medical training colleges and medical schools

To improve service delivery of immunization services through provision of at least one vehicle per

Advocacy at all levels

Conduct transport inventory

Undertake advocacy of district at national, district and constituency levels

Review progress of success


Table 8: Advocacy and Communication

National Objective

Strategy

Key Activities

district

To regularize data driven quarterly EPI supervisory visits by national, provincial and district teams by 2011

Planning of supervisory visits

Prepare immunization supervisory plan

Evidence generation

Carry out monthly immunization data analysis

Monitoring performance

Undertake quarterly EPI focused support supervision

Give feedback and feed-forward on the findings of the supervisory visit

To establish the impact of vaccines on the burden of the targeted diseases and burden of disease due to congenital rubella syndrome by 2015

Surveillance Conduct a congenital rubella syndrome baseline survey

Impact studies To carry out a seroprevalence survey of yellow fever and entomological study in high risk districts

To carry out impact of introduction of rota virus vaccine

To accelerate integrated implementation of high impact child survival interventions to reach all districts by 2015

Technical support on incorporation of immunization components of the HII

Undertake joint planning, implementation and M&E

To monitor and evaluate Kenya’s immunization program by 2015

Data management Undertake on job training on data management

Conduct periodic DQS at all levels

Conduct monthly data analysis and feedback at all levels

Print and distribute data capture and reporting tools

Validation of EPI performance

To undertake EPI coverage survey

Vaccine safety Carry out AEFI monitoring


To develop and implement an advocacy and communication plan for immunization in all districts by 2013

Development of advocacy and communication plan

Do a KAP survey to identify barriers for effective communication Develop the advocacy and communication plan

Implementation of the advocacy and communication plan

Dissemination of the plan

Identify and train district level focal people in social mapping and use of data for communications

Social and resource mapping, including of underserved populations

Training package developed for IPC skill development of health workers

Media training and partnership development

Prepare communication messages for specific target audience

Monitor the implementation of plan

Table 9: Surveillance

National Objective

Strategy

Key Activities

To sustain core indicators for AFP and Measles by 2015 To attain NNT elimination by 2012

To attain PBM and Rotavirus indicators by 2015

Improve sensitivity of surveillance system

Carry out cross border surveillance

Undertake quarterly surveillance review meetings at all levels

Carry out risk assessment/analysis

Strengthen the capacity of health workers on surveillance

Carry out on job training during support supervision at all levels

Training of newly recruited health workers and the new DHMTs

Scale up IDSR roll out

Supply of essential laboratory, data documentation and communication materials

Production IEC

Stocking of polio and measles lab reagents and equipments

Print and distribute data capture tools

Improve surveillance data quality

Conduct monthly data harmonization meeting

Timely submission of surveillance data

Table 10: Vaccine supply Quality and Logistics

National Objective

Strategy Key Activities

To increase the number of districts

Planning for cold chain equipments

Conduct comprehensive cold chain assessment at all levels


with functional cold chain at the district stores from 61% to 95% by 2015

Develop and implement a cold chain maintenance plan

Develop a cold chain replacement and expansion plan at national level

Increasing cold chain capacity

Procure cold chain equipments

Secure budget for the procurement of cold chain equipments

Lobby for funding from GOK and partners

To attain 100% of districts with no stock outs of vaccines at the district stores by 2013

Planning for vaccines and other supplies

Conduct accurate vaccine forecasting at national and district levels to ensure uninterrupted supply of vaccines

Develop a procurement plan

Develop a quarterly distribution plan in line with shipment plan

Provide adequate and well functioning transportation system to all districts

Secure funds for purchase of vaccines

Lobby for adequate finances for vaccines and other supplies through high level advocacy Ring fencing funds for vaccines and other supplies

Efficient vaccine management and distribution of vaccines at all levels

Procure vaccines on time

Fasten clearance of vaccines after arrival in the country

Install stock management tool at all level

Decentralize vaccine distribution mechanism to improve vaccine availability at the lower level

Improve vaccine handling and storage

Train logisticians and health workers on vaccine handling and storage at all levels

Improve bundling of vaccines and diluents

Reduce vaccine wastage to recommended levels

Monitor vaccine wastage at all levels Develop communication system to improve reporting of wastage

To attain 100% of the districts with waste disposal mechanism by 2015

Capacity strengthening of health care workers on health care waste management

Disseminate health care waste management guideline to all levels

Train newly recruited health care workers on health care waste disposal

Provide safe methods of waste

Construct at least one incinerator in each district


disposal Construct at least a waste disposal pit in each health facility

To sustain 100% supply of safe injection supplies and practices by 2015

Planning for AD syringes and safety boxes

Conduct accurate forecasting for AD syringes and safety boxes at all levels

Develop a procurement plan

Develop a quarterly distribution plan in line with shipment plan

Provide adequate and well functioning transportation system to all districts

Secure funds for purchase of injection and safety devices

Lobby for adequate finances through high level advocacy

Ring fence funds

Efficient supply and distribution of AD syringes and safety boxes at all levels

Procure AD syringes and safety boxes on time

Fasten clearance of vaccines after arrival in the country Install stock management tool at all level

Decentralize distribution mechanism

Improve handling and storage

Train logisticians and health workers at all levels

Implement AD bundling policy with every vaccine in every district Improve district reporting on AD use

Train the providers on safe injection practices


8 COSTING, FINANCING AND FINANCIAL SUSTAINABILITY

8.1 Costing and financing methodology

The success of the programme largely depends on adequate financing for all proposed

activities to be undertaken during the planned period. It will be the responsibility of DVI

through the Ministry of Public Health and Sanitation to ensure that the programme gets

adequate financial and material support both locally and internationally. In this section, we

review the cost implications of the proposed programme activities, and relate these to the

known available finance for respective cost categories of the programme to derive

information relating to financial gaps. The cMYP includes a series of interventions, which

have associated activities, and inputs needed to actualise. These are illustrated in the Table

11 below.

Table 11: Inputs to different EPI systems components

System Components

Inputs Activities

Service delivery Human resources/salaries, outreach per diems, fuel for transport, operation costs for campaigns

Training, workshops, outreaches, SIAs, Supervision, Monitoring and Evaluation


IEC materials, radio, print media advertisements etc.

Social mobilization, IEC, developing advocacy and communication plan

Surveillance Surveillance equipment, laboratory networking and reagents etc.

Surveillance meetings and activities (sentinel sites, outbreak investigation), case investigation and follow-up.

Vaccine, supply, quality and logistics

Vaccines, AD syringes, safety boxes, other injection supplies, cold chain equipment, vehicles, spare parts, incinerators etc.

Monitoring, vaccine stock management activities

Programme Procurement of land and Meetings, planning, research, data


The above listed activities and inputs are what are costed. The costs for the programme are

derived in a variety of costing methodologies, depending on the interventions planned.

These include:

• The ingredient approach, based on the product of unit prices, and quantities

needed each year, adjusted for the proportion of time used for immunization. This is

used for costing inputs such as vaccines, personnel, vehicles, cold chain equipment,

etc.

• Rules of thumb, which are based on immunization practice, such as a

percentage of fuel costs as representative of maintenance costs for vehicles. This is

used for deriving costs for injection supplies, and maintenance of equipment, and

vehicles.

• Past spending, where lump sum past expenditure is used to estimate future

expenditure. For example, past cost per child for specific campaigns, training

activities etc.

These different approaches are all brought together in a pre-designed cMYP excel costing

tool and derived costs based on the following components:

• Vaccines and injection supplies

• Personnel costs (EPI specific and shared)

• Vehicles and transport costs

• Cold chain equipment, maintenance and overheads

• Operational costs for campaigns

• Programme activities, other recurrent costs and surveillance

• Other equipment needs and capital costs

• Overhead costs.

Management construction of KEPI HQs, computers, office supplies.

management, EPI reviews, cold chain assessment.


8.2 Macroeconomic Information

For purposes of placing the costing and financing information into wider financing

framework, some macroeconomic information has been included. This information is

detailed in the Table 12 below. The GDP per capita has been fixed at the 2010 levels

though this may increase with time but has been fixed for planning purposes. The

Government health expenditure is expected to increase in line with the government’s plans

and agenda to improve health care service and health care delivery in line with Kenya

vision 2030 which recognises health as an important pillar for development and

industrialisation of Kenya.

Table 12:Macro Economic Trends in Kenya, 2010 – 2015

YEAR 2010 2011 2012 2013 2014 2015

GDP per capita $ 761 $ 837 $ 921 $ 1,013 $ 1,114 $ 1,226

Total health expenditures (THE) per capita $42.2 $ 56.3 $ 56.3 $ 59.5 $ 61 $ 62.5

Government health expenditures (GHE) as a % of THE 29.0% 29% 29% 29% 29% 29%

National health accounts figures are available from the WHO NHA website

http://www.who.int/nha/country

8.3 Cost projections 2011-2015 for immunization programme

The projected cost of the programme in the planning period (2011-2015) is $378

million dollars. The cost will increase from 2010 to 2015. The major cost drivers are

routine recurrent costs, new vaccines, personnel and traditional vaccines continue to

dominate all other costs of the immunization program in the years of the cMYP. The

introduction of pneumococcal vaccine in January 2011 and Rotavirus vaccine in January

2013 will lead to a rapid increase cost of vaccines and therefore an increase in co

financing requirement by the government. The Government is cognisant of these

requirements and will ensure funds are available. To mitigate the increasing cost of

vaccines the Government is also converting to a 10 dose liquid formulation of

pentavalent vaccine from a 2 dose lyophilized formulation. This vaccine formulation


will reduce costs to the Government and GAVI and also reduce pressure on our cold

chain requirements.

More details on the cost categories are shown in table 13 below.

Table 13: Programme costs and Future Resources Requirements

2011 2013 2014 2015 2016 2017

$ $ $ $ $ $

Traditional vaccines (BCG; OPV; Measles; TT; DTP) $2,106,938 $3,478,677 $3,566,948 $3,663,252 $3,762,163 $3,762,163

Underused vaccines (YF; Rubella, HepB; Hib; DTPcombo) $7,510,709 $8,608,086 $9,410,969 $9,583,553 $9,842,429 $9,842,429

New vaccines (Rota, Pneumo, HPV...) $19,963,300 $24,785,829 $24,027,522 $24,263,527 $24,918,192 $24,918,192

Cost of Injection Supplies $ $ $ $ $ $

Traditional vaccines (BCG; OPV; Measles; TT; DTP) $394,030 $553,371 $567,493 $582,817 $598,506 $598,506

Underused vaccines (YF; Rubella, HepB; Hib; DTPcombo) $222,050 $239,563 $261,912 $266,694 $273,927 $273,927

New vaccines (Rota, Pneumo, HPV...) $290,000 $243,636 $249,903 $254,689 $261,876 $261,876

Table 14: Programme costs and Future Resources Requirements

8.4 Cost profile

Program expenditure in the baseline year was US$ 206,600,722 of which US$194,588,492

is attributable to the routine recurrent program, with just under US$ 12,012,230 to the

supplemental immunization campaign activities. The expenditure breakdown for the

routine immunization program is further illustrated in the Figure 10 below.


Figure 12: Basline Cost Profile Routine Only

The major cost drivers in the baseline year are new vaccines that contribute 49% of the

baseline cost while traditional vaccines account for 5% the total cost. Personnel account for

15% and other recurrent costs account for 11% of the total cost. The use of new and under

used vaccines such as pentavalent vaccine, yellow fever vaccine and PCV contribute heavily

to the cost of vaccines. Kenya plans to introduce rotavirus vaccine and second dose of

measles in 2013 which will increase the cold chain requirement and total cost of vaccines.

8.5 Baseline Financing

In terms of baseline financing, Government of Kenya (GoK) contributed 20%. The GAVI

alliance contributed to 65% of the cost and this was due to the cost of new vaccines. Other

partners contributed 15% of the cost. The Government fully financed all the traditional

vaccines and personnel cost associated with giving immunization. GAVI finance was used in

procurement of new and under used vaccines and injection supplies. Other partner

contributions were utilized in the financing of supplementary immunization activities and

Traditional Vaccines

5%Underused

Vaccines18%

New Vaccines49%

Injection supplies

2%

Personnel15%

Transportation0%

Other routine recurrent costs

11%

Vehicles0%

Cold chain equipment

0%

Other capital equipment

0%


surveillance and other activities. A breakdown of the contributions is shown in Figure 11

below.

Figure 13: Baseline Financing Profile

8.1 Cost by immunization strategy

From Figure 12 below, dominant strategy of immunization in Kenya is fixed strategy.

Outreach strategy is the second; while the third strategy is the mobile. Fixed strategies are

planned and expected t increase in line with government plans to increase fixed facilities at

all levels. Outreach will be a strategy for hard to reach and pastoralist communities. Major

SIAs are scheduled to take place in 2012 and 2015.

Government19%

Gov. Co-Financing of GAVI Vaccine

7%

GAVI65%

WHO5%

UNICEF4%

JICA0%

CHIA0% GSK

0%


Figure 14: Costs by Strategy

8.2 Projected future resource requirements for immunization from all sources from 2011-2015.

From the figure below, the total costs for immunization programme will increase from

about $206,602,722 in 2011 to $270,855,729 by 2015. The requirements will increase

significantly from 2011 till 2013 and then plateau till 2015 with marginal increase. This is

because Kenya plans to introduce rota virus vaccine by 2013.

$0.0

$50.0

$100.0

$150.0

$200.0

$250.0

$300.0

2013 2014 2015 2016 2017

M

i

l

l

i

o

n

s

Costs by Strategy**

Campaigns Routine Fix Site Delivery Outreach Strategy Mobile Strategy


Figure 15: Projection of future resource requirements 2011-2015

8.3 Projected future financing: Secured, probable and gaps for immunization from 2011-2015.

The secured funding for the year 2013 is over $46million and it increases to close to $60

million by 2015. The funding gap taking into account secured funds only is approximately

10% of the total needs and when probable funding is taken into account the funding gap

reduces to 8% in 2011 and by 2015 the funding gap is only 2% of the total needs.

The bulk of the funding (secured and probable) is from government of Kenya and GAVI

while WHO, UNICEF and JICA play a big role. Other partners offer programme support and

they include USAID/MCHIP, SABIN, AMP, GSK, Merck vaccine foundation and micronutrient

$-

$10.0

$20.0

$30.0

$40.0

$50.0

$60.0

$70.0

2013 2014 2015 2016 2017

M

i

l

l

i

o

n

s

Projection of Future Resource Requirements**

Traditional Vaccines Underused Vaccines

New Vaccines Injection supplies

Personnel Transportation

Other routine recurrent costs Vehicles

Cold chain equipment Other capital equipment

Campaigns


international make up probable funders. The funding projection s is line with their

historical support to the programme.

Figure 14 and 15 show the financing gaps.

Figure 16: Projection of future financing gap

$0.0

$10.0

$20.0

$30.0

$40.0

$50.0

$60.0

$70.0

2013 2014 2015 2016 2017

M

i

l

l

i

o

n

s

Government County Gov.Gov. Co-Financing of GAVI Vaccine GAVIWHO UNICEFJICA USAID/MCHIPCLINTON HEALTH ACCESS INITIATIVE MICRO-NUTRIENT INTERNATIONALMERCK VACCINE FOUNDATION SABIN VACCINE FOUNDATTIONGSK

FUNDING GAP


Figure 17:Future Secure and probable financing gaps

$0.0

$10.0

$20.0

$30.0

$40.0

$50.0

$60.0

$70.0

2013 2014 2015 2016 2017

M

i

l

l

i

o

n

s

Government County Gov.Gov. Co-Financing of GAVI Vaccine GAVIWHO UNICEFJICA USAID/MCHIPCLINTON HEALTH ACCESS INITIATIVE MICRO-NUTRIENT INTERNATIONALMERCK VACCINE FOUNDATION SABIN VACCINE FOUNDATTIONGSK

FUNDING GAP

Formatted: Caption, Don't keep with

next


Figure 18: The funding gap and selected indicator


9 Annexes

9.1 Annex 1: Activity timeline 2011-2015

Key Activities Responsibilities 2011 2012 2013 2014 2015

Conduct monthly defaulter tracing x x x x x


x x x x x


x x

x x x

Hold periodic community stakeholders meetings at the health facility

x x

x x x


x x

x x x


x x x x x

x x x x x


x x x x x


x

Implement SIAs for WCBA in high risk areas

x

TT validation x



x x x x x



x x x x x


x x x x x


x x x x x


x x x x x


x x x x x



x x x x x



x x x x x


x x x x x


x x x x x

To conduct follow up immunization campaign of high risk population


x


x

Develop a budget and mobilize resources for introduction of measles second dose

x


x


x

Conduct EVMA x


x


x

Development of training materials x

Training of health workers x


x


x


x



x


x


x


x


x

Conduct EVMA x


x


x




x


x


x

Conduct PVC10 impact studies x x x x

Conduct AEFI studies x x x x


x


x

Develop a budget and mobilize resources for introduction of rota virus vaccine

x


x


x


x


x


x




x


x

National, provincial and district launch

x

Revise, print and distribute all data collection tools

x

Monthly review of performance of rotavirus vaccine

x x x

Conduct AEFI study including intussusception

x x x

Development and submission of proposal to GAVI

x

Set up sites x

Document lessons from the study

x x

Plan for national rollout of HPV

x x

Conduct measles follow up SIA x

Conduct preventive polio SIAs in high risk districts

x x

x x

Conduct TT SIAs in high risk districts

x

Conduct risk assessment for MNT x x x x x

Carry out MNT validation exercise

x

Seek approval from child ICC and endorsement from HSCC

x x x

Print and distribute the plan to all stakeholders

x x x



x x x


x x

x x x


x x x

Develop district micro-plans x x x x x

Annual update of the cMYP x x x x x


x

Prepare an economic evaluation brief on immunization

x

Prepare a resource mobilization information package

x


x x x x

Sustainability plan for Penta/pneumo and other new vaccines

x x


x

Conduct joint planning and coordination meetings

x x x x x

Conduct joint review of performance

x x x x x

Mapping of immunization stakeholders and potential funding agencies.

x x x x x


x x x x x


x x x x x


Conduct immunization HR gap assessment

x


x

Lobby deployment of HR to critical areas of need

x x x x x


x x x x x

Print and disseminate Immunization policy and guidelines on vaccine preventable diseases

x


x


x

Carry out phased training incorporating the RED/DQS approach targeting all health workers involved in immunization, especially newly recruited staff

x x x x


x

Conduct transport inventory x

Undertake advocacy of district at national, district and constituency levels

x x

Review progress of success x x


x


x x x x x


x x x x x


Give feedback and feed-forward on the findings of the supervisory visit

x x x x x

Conduct a congenital rubella syndrome baseline survey

x x

To carry out a seroprevalence survey of yellow fever and entomological study in high risk districts

x

To carry out impact of introduction of rota virus vaccine

x x


x x x x x

Undertake on job training on data management

x x x x x

Conduct periodic DQS at all levels x x x x x

Conduct monthly data analysis and feedback at all levels

x x x x x

Print and distribute data capture and reporting tools

x x x x x

To undertake EPI coverage survey x

x

Carry out AEFI monitoring x x x x x


9.2 Annex 2: Annual operational plan 6 (AOP 6) Family Health Department

DIVISION OF VACCINES & IMMUNIZATION – AOP-6 2010/2011

Result Area

Interventions/Activities

Responsible Person Timeframe Estimated

cost

Available Unfund

ed

Q1

Q2

Q3

Q4 Amount Source

1. Policy Formulation and Strategic Planning

Vaccination policy printed and disseminated to stakeholders

Head- DVI X X X X 5,000,000 5,000,000

WHO/GOK

Guidelines on other vaccine preventable diseases produced and disseminated

Quality Control and Commodity Assurance X X X X 6,100,000 6,100,000 WHO 0

2. Security for Public health Commodities

Forecasting of routine emergency and new vaccines and injection equipment completed Logistics X 5,000 5,000 GoK 0

Vaccines and injection equipment procured and distributed Logistics X

664,715,135

664,715,135 GoK

National Cold Chain Inventory conducted Logistics X X X X 30,000,000 30,000,000

UNICEF/GOK 0

Additional cold chain equipment installed Logistics x X X X 20,000,000 20,000,000 GoK 0

Cold chain equipment maintained Logistics X X X X 6,500,000 6,500,000 GoK 0

3. Performance monitoring

Routine immunization data by levels maintained. Data X X X X 50,000 50,000 G.O.K 0

Vaccines monitoring tools procured and distributed

Logistics and Procurement X 32,000,000 32,000,000 GoK 0

Vaccines monthly Physical stock taking Logistics 10,000 10,000 GoK 0

National routine immunization module updated. Data X X X X 500,000 0

GOK GAVI

WHO 500,000

Districts trained on Target setting , Vaccine forecasting and micro-planning for EPI improvements in 60 poor performing Districts

Data, Training, Logistics X X 11,000,000 11,000,000

UNICEF/GOK 0


Result Area

Interventions/Activities

Responsible Person Timeframe Estimated

cost

Available Unfund

ed

Q1

Q2

Q3

Q4 Amount Source

Integrated tools for vaccines preventable illness developed.

Data and Logistics X X 200,000 200,000 GoK 0

Data quality self assessment to 154 districts conducted.

Data Training, X X 13,000,000 13,000,000

UNICEF 0

4. Capacity strengthening

DVI Quarterly newsletter developed and disseminated Data X X X X 1,000,000 1,000,000 GoK 0

Health workers skills on demand creation enhanced. Advocacy X X 8,450,000 8,450,000 WHO 0

Transport, supplies and communication systems efficient

Administration and Procurement X X X X 2,861,667 2,861,667 GOK 0

DHMTs trained in MLM in Eastern and Central Provinces Training X X X X 5,000,000 5,000,000

MERCK

Vaccine

Network/GO

K 0

Media clips prepared and transmitted Advocacy X X X X 1,700,000 1,700,000

GOK/UNICEF 0

5. Resource Mobilization

Annual Work plan and Budget and Preparation of MTEF prepared Head- DVI X 10,000 10,000 GoK 0

6. Operational research

Batch testing at all levels

Quality Assurance and Commodity Assurance X X X X

2,000,000 0

GOK/WHO

2,000,000

Total X X X X 779,881,802

777,381,802

2,500,000

9.3 Annex 3: Annual work plan 2011/2012, Division of vaccines and immunization

(Aligned to Government of Kenya planning cycle)

Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Sep

tem

be

r

Oct

ob

er

No

vem

be

r

De

cem

be

r

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Pa

rtn

ers


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

Service delivery and Programme Management

1.Conduct outreaches in identified priority areas

High risk district/Health facilities

X

X X X X X X X X X X X

2.Carry out Vitamin A supplementation in all ECD centers

X X X X X X X X X X X X

3.Conduct monthly defaulter tracing

Health facilities with defaulters/unvaccinated children


4.Conduct quarterly reviews meetings at national, provincial and district levels

All district

X X X X

5.Hold quarterly community stakeholders meetings

Health facility/ community


6.Conduct monthly data analysis and dissemination meetings at each level

All levels X X X X X X X X X X X

X


National/district

X X X X


All health facility catchment areas

X X


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

(Malezi Bora) Conduct regular audits of yellow fever vaccine

4 high risk districts


Constitution and launch of the national Pneumococcal steering committee, technical coordinating committee and sub-committees

National level-August 2010

Development of district micro plans for pneumococcal vaccines

Districts-October 2010


National-October 2010

Source for technical assistance (Training, Communication and Cold Chain/Logistics) from partners

National-August 2010

Conduct cold chain inventory

All levels-October 2010


All levels-Oct 2010

Develop PCV-10 training materials

National-August/Sept 2010

Train health All levels-Oct.


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

workers PCV-10 2010 Develop, print and distribute communication materials for roll out of PCV-10

All-Nov 2010

Conduct stakeholders sensitization meetings at all levels for introduction of PCV-10

All levels-Nov 2010

National, provincial and district launches for PCV-10

Nov 2010

Revise, print and distribute all data collection tools that include PCV-10

All levels Oct-Nov 2010

Pre, process and post introduction monitoring and evaluation

All levels X X X X X X X X X X X X

Conduct catch up campaign in two districts (Bondo and Kilifi)

Conduct AEFI study

Conduct cold chain inventory



Conduct preventive polio SIAs in high risk districts

X


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

Conduct risk assessment for MNT

Sept. 2010

Conduct TT SIAs in high risk districts

High risk districts X

Seek approval from child Health ICC and endorsement from HSCC (cMYP)

National-August 2010

Print and distribute the cMYP plan to all stakeholders

All levels-October 2010


November 2010


National X X X X X X X X X X X X


National-September 2010

Annual update the cMYP

National X


Annual X

Prepare an advocacy economic evaluation brief on immunization and present to policy and planning team,

National-September 2010

Develop a costing model for immunization activities and use for advocacy

October 2010-March 2011

X X X


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

Prepare a resource mobilization information package and present to policy and planning team

National

X


X


X X

X

X

Develop sustainability plan for Penta/Pneumo and other new vaccines

X X X X X X



Conduct joint planning and coordination meetings

All levels X X X X X X X X X X X X

Conduct joint review of performance

National/Province/District X

Map immunization stakeholders and potential funding agencies.

All levels-starting with National

X X X X




Conduct National level


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

immunization HR gap assessment


National level

Lobby deployment of HR to critical areas of need

National level


National level



X

X

X

X


National level

Carry out training targeting newly recruited health workers and in prioritized districts





Give feedback and feed-forward on the


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

findings of the supervisory visit

Conduct a congenital rubella syndrome baseline survey

To carry out a sero-prevalence survey of yellow fever and entomological study in high risk districts

To undertake impact study of pneumococcal vaccine introduction

To carry out impact of introduction of rota virus vaccine introduction

Select high impact interventions HII at the districts

Develop of operation of high impact intervention


Undertake on job training on data management

Conduct periodic DQS at all levels

Conduct monthly data analysis and feedback at all


Act

ivit

ies

Consolidated

and Integra

ted activiti

es

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

De

cem

ber

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it r

esp

on

sib

le

Co

st$

Funds availabl

e

Sh

ort

fall

Go

ve

rnm

en

t.

Par

tne

rs

levels Print and distribute data capture and reporting tools

To undertake EPI coverage survey

Carry out AEFI monitoring


Activities W

her

e

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

ve

mb

er

Dec

emb

er

Jan

uar

y

Feb

rua

ry

Mar

ch

Ap

ril

May

Jun

e

Un

it

Co

st$


Do a KAP survey to identify barriers for effective communication

Develop the advocacy and communication plan

Dissemination of the plan

Prepare communication messages for specific target audience

Monitor the implementation of plan

Activities

Wh

ere

July

Au

gu

st

Sep

tem

be

r

Oct

ob

er

No

vem

be

r

De

cem

be

r

Jan

ua

ry

Fe

bru

ary

Ma

rch

Ap

ril

Ma

y

Jun

e

Un

it

Co

st$

Surveillance

Undertake quarterly surveillance review meetings at all levels

Carry out risk assessment/analysis

Carry out on job training during support supervision at all levels

Training of newly


recruited health workers and the new DHMTs

Scale up IDSR roll out

Production IEC Stocking of polio and measles lab reagents and equipments

Print and distribute data capture tools

Conduct monthly data harmonization meeting

Timely submission of surveillance data

Activities

Wh

ere

July

Au

gu

st

Se

pte

mb

er

Oct

ob

er

No

vem

be

r

Dec

emb

er

Jan

uar

y

Feb

rua

ry

Mar

ch

Ap

ril

May

Jun

e

Un

it

Co

st$

Vaccine supply, quality and Logistics

88.Conduct comprehensive cold chain assessment at all levels

89.Develop and implement a cold chain maintenance plan

90.Develop a cold chain replacement plan at national level

91.Procure cold chain equipments

92.Lobby for funding from GOK and partners

93.Conduct accurate vaccine forecasting at


national and district levels to ensure uninterrupted supply of vaccines

94.Develop a procurement plan

95.Develop a quarterly distribution plan in line with shipment plan

96.Provide adequate and well functioning transportation system to all districts

97.Lobby for adequate finances for vaccines and other supplies through high level advocacy

98.Ring fencing funds for vaccines and other supplies

99.Procure vaccines on time

100. Fasten clearance of vaccines after arrival in the country

101. Install stock management tool at all level

102.Decentralize vaccine distribution mechanism to improve vaccine availability at the lower level

103. Train logisticians and health workers on vaccine handling


and storage at all levels

104.Improve bundling of vaccines and diluents

105. Monitor vaccine wastage at all levels

106. Develop communication system to improve reporting of wastage

107.Disseminate health care waste management guideline to all levels

108.Train newly recruited health care workers on health care waste disposal

109.Construct at least one incinerator in each district

110.Construct at least a waste disposal pit in each health facility

111.Conduct accurate forecasting for AD syringes and safety boxes at all levels

112.Develop a procurement plan

113.Develop a quarterly distribution plan in line with shipment plan

114.Provide adequate and well functioning transportation system to all


districts

115.Lobby for adequate finances through high level advocacy

116.Ring fence funds

117.Procure AD syringes and safety boxes on time

118.Fasten clearance of vaccines after arrival in the country

119.Install stock management tool at all level

120.Decentralize distribution mechanism

121.Train logisticians and health workers at all levels

122.Implement AD bundling policy with every vaccine in every district

123.Improve district reporting on AD use

124.Train the providers on safe injection practices


9.4 Annex 4: Using GIVS framework as a checklist

GIVS strategies

Key activities Activity included in MYP

Strategic Area One: Protecting more people in a changing world Y N Not

Applicable

New activity needed

Strategy 1: Commit and plan to reach everyone

Strengthen human resources and financial planning

x

Protect persons outside the infant age group x

Improve data analysis and problem solving x

Sustain high vaccination coverage where it has been achieved

X

Include supplemental immunization activities

x

Strategy 2: Stimulate community demand for immunization

Assess the existing communication gaps in reaching all communities

x

Engage community members and non-governmental organizations

x

Develop communication and social mobilization plan

x

Match the demand X

Strategy 3: Reinforce efforts to reach the unreached in every district

Micro-planning at the district or local level to reach the unreached

X

Reduce drop-outs X

Strengthen the managerial skills X

Timely funding, logistic support and supplies

X

Strategy 4: Enhance injection and immunization safety

Procure vaccines from sources that meet internationally recognized quality standards

X

Ensure safe storage and transport of biological products under prescribed conditions

X

Introduce, sustain and monitor safe injection practices

X

Establish surveillance and response to adverse events following immunization

X

Strategy 5: Strengthen and sustain cold chain and logistics

Conducting accurate demand forecasting activities

X

Building capacity for stock management X


GIVS strategies

Key activities Activity included in MYP

Strategic Area One: Protecting more people in a changing world Y N Not

Applicable

New activity needed

Effective planning and monitoring of cold chain storage capacity

X

Firm management system of transportation and communication equipment

x

Strategy 6: Learn from experience

Regular immunization programme reviews X

Operations research and evaluation X

Model disease and economic burden as well as the impact

X

division of vaccines and immunisation comprehensive multi year

Documents