Immunization service delivery – immunization management prospective

Service delivery

• A step within the immunization system • Immunization service delivery : a service

based on principles, standards, policies, strengths and weakness

• All children have the right to get vaccinated with safe vaccines at the right time at the right place.

Setting the standards

- Vaccinations are offered :- Primary care centers – baby clinics, health

posts (fixed post sites and outreach activities)

- Outreach activities – community participation - Private sector – primary and secondary care - Main standards for all of them: cold chain,

administration of vaccine, injection safety and trained personnel.

Primary care

• Getting the vaccine – PLANNING (knowing the community, monthly plans etc)

• Empower nurses and doctors • Primary care service standards and duties

( immunization service delivery: planning, management, coordination, vaccine administration, supervision, trained staff)

• Financing

- Planning and coordination of primary care services with district immunization management -vaccines, syringes, safety boxes, cold chain monitoring devices-Instructions related to the vaccines, producers etc.-Ensuring vaccine quality – central level

Vaccine supply and quality

Planning

Planning and supervision by district manager

Logistics

• Transportation of vaccines to primary care centers

• Cold chain • Ensure vaccination of every

child from maternity to primary care services

• SMS • Door to door activities

performed by fixed posts nurses

• Coverage • Identification of unvaccinated children • AEFI• Info about supplies• Registries • Information Immunization system

- Piloted in 2010 -2012 - Scale up activities since 2013

Surveillance and monitoring

Why IIS • Questions about data quality• Overall coverage data alone is

not enough to manage program• Lack of timeliness of information• New expensive single dose

vaccines need to be better managed

• Workload for nurses, district officers and reduction of staff

• No access to immunization records for other districst ( internal migration)

• Lack of effective collaboration between nurses

How?

1. Track individual children’s schedules to:• Ensure timely vaccination of

all registered children• Improve coverage data

quality• Supply vaccine based on real

demand• Learn reasons for non-

vaccination• Track vaccine lots down to

the child record

Vaccines are distributed together with the list of children to be vaccinated

Where the problem is- beyond 5%

Analytical reports• Cohort coverage: immunization status of all registered

children in a certain cohort

• Fully immunized children: FIC coverage as well as drop-

out rates between certain antigens

• Coverage compared to plan: % vaccinated in a certain

year compared to the number of children that was

planned for vaccination in that year

• Vaccination activities: vaccinations administered by a

certain health

• Stock balances: available stock balance in the store by

vaccine, compared to preset minimum and maximum

levels.

• Vaccine wastage: how many doses of each vaccine were

used, administered, and wasted by facility.

• Wastage by reason: reported as wasted by reason code

• Lot tracing: shows were each vaccine lot was distributed,

and to which children it was administered.

Empower nurses and parents

• Training of nurses and collaboration

• Parents with their ID have their account and may learn more about vaccination of their children, timing, and may print vaccination cards

Financial incentives

• Performance based bonus - Incentives for good immunization coverage for primary care centers

• Incentives for community outreach

Other

• Immunization card and nursery, kinder garden and school registration

• Collaboration with Roma organization and offering vaccines in their communities

Private sector• Part of immunization servce delivery • Offered in primary and secondary care • National standards applied for them• Identification and registration of vaccination

activities• Following the same schedule with more

expensive vaccines • Ensure cold chain, injection safety and education

standards• Provide information to public clinics when

needed

A cadre of trained staff on immunization A package of information for each health care center-Gaps on training but in general every nurse in the country must have a basic vaccination training and know the vaccines they are administrating-Lack of communication big cities – Tirana capital -More advocacy, communication training

Training, Advocacy and communication

Thank you