integrated measles best practice sia 2010/2011
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Integrated Measles Best Practice SIA 2010/2011. Experience from Ethioipia Global Measles and Rubella Meeting, 15-17 March 2011, Geneva. Outline. Background Measles coverage and epidemiological situation Ethiopia SIA Experience SIA implementation/achievement SIA evaluation - PowerPoint PPT PresentationTRANSCRIPT
Integrated Measles Best PracticeSIA 2010/2011
Experience from EthioipiaGlobal Measles and Rubella Meeting, 15-17 March 2011,
Geneva
OutlineOutline
• Background• Measles coverage and epidemiological situation• Ethiopia SIA Experience• SIA implementation/achievement• SIA evaluation• Opportunities and challenges
Ethiopia: BackgroundEthiopia: BackgroundFederal Ministry of Health
Regional Health Bureaux(9 Regions + 2 City Administrations)
Zonal Health adminstration(98 Zones)
819 Woreda Health Offices
15,000 Kebeles 1 health post per 5,000 population) :- The
key for the success of the SIA
• Projected population 2010 (census 2007): 79 million– Growth Rate: 2.6% – Under-1: 3.2% (1.9m)– Under-5: 14.6% (11.4m)– Under-15: 45% (35m)
• Rural: 83%
• Infant Mortality Rate: 75/1000 live-births
Reported Measles Cases and Measles Reported Measles Cases and Measles Coverage- 1990-2009, EthiopiaCoverage- 1990-2009, Ethiopia
Catch Up 2002 -2004
Best practice 2010
Measles Outbreaks - 2010Measles Outbreaks - 2010Vaccination status of confirmed
measles cases. January – Dec 2010Confirmed Measles cases
January - Dec 2010
Measles SIAs: 2010-2011Measles SIAs: 2010-2011• Target: 8.5 million children
aged 9 – 47months– 90.8% of target population in 2010
• Dates: – 22 - 25 October 2010– 18-21 February 2011
• Objectives of SIA: – Give 2nd dose of measles vaccine– Identify ,implement and evaluate best
practice SIA
• Integrated interventions:– OPV (0-59 months)– Vitamin A (6-59 months)– De-worming (24-59 months)– Nutritional Screening (6-59 months
and pregnant and lactating women)
2010
2011
Pre-Identified SIA Best PracticesPre-Identified SIA Best PracticesCoordinationCoordination• National and sub national Task Force
with subcommittee's led by government health bureau
• Weekly updates from each level for management and monitoring of SIA
LogisticsLogistics• Required logistics available pre SIA
with initiation of distribution 3-4 weeks before implementation
• Flexibility in distribution mechanisms including transport fleet for emergency distribution
Micro planning and TrainingMicro planning and Training• Emphasis on Kebele level planning
with identification of hard to reach and difficult populations
• Participatory approach in training .
Advocacy and Social MobilizationAdvocacy and Social Mobilization• High level political engagement• Advocacy visit to regional presidents• Evidence-based messages (KAP)• Diverse channels of communication
• radio, tv, town criers, house to house canvassing, schools, banners, IEC, mobile vans
Pre – Identified SIA Best Practices Pre – Identified SIA Best Practices Monitoring and EvaluationMonitoring and Evaluation
• Pre campaign assessments (3-4 weeks and 1 week prior to SIA) and feedback given to address gaps
• Different methods utilized to monitor performance:
– Daily review meetings, with daily coverage reporting using SMS ( second phase)
• Administrative, rapid convenience monitoring, independent monitoring
Resource MobilizationResource Mobilization
• Significant Government contributions :- .017 cost per child
• High level cooperation between EPI partners
• Engagement of partners at all levels:
o Human resources, transport, social mobilization, logistics
Implementation of Best Practice Implementation of Best Practice Integrated Measles SIAIntegrated Measles SIA
Funding for 2010/11 Measles SIAs Funding for 2010/11 Measles SIAs
Item
Total Budget (USD) FMOH
Nutrition Partners
(EOS)
Funding from the Measles Initiative
Global Polio
InitiativeWHO UNICEFVaccine and injection materials 5,371,901 3,345,097 2,026,804
Operational costs 6,464,204 746,219 1,502,205 2,101,540 1,364,240 750,000
Grand Total 11,836,105 746,219 1,502,205 2,101,540 4,658,097 2,776,804Target population (< 5) 12,859,245
Cost per child (USD) 0.92
Coordination activities:- weekly meeting
A National task force led by the DG of Health Promotion and Disease Prevention Directorate, FMoH taking care of the coordination of preparation Regional level task force led by RHB-PHEM head
Launching ActivitiesLaunching Activities
ImplementationImplementation
SIA Administrative Coverage, SIA Administrative Coverage, Ethiopia, 2010-11Ethiopia, 2010-11
>=95%
90-94%
80-89%
Measles Coverage OPV Coverage
National coverage 106% National coverage 97%
Independent Monitoring Assessment Independent Monitoring Assessment of Woreda Performance, Ethiopia 2010of Woreda Performance, Ethiopia 2010
Proportion of Children missed during the SIA
Number of woredas for measles vaccination
Number of woreda for Polio Vaccination
>10% 106 107
5-10% 67 79
<5% 222 209
Source of data: Post SIA Independent monitoring, 38 6Woredas (52%) sampledNote: Poor quality finger markers compromised the independent monitoring process in several areas
Evaluation of the Ethiopian measles SIAs
Methodology Objective of the Survey
• Cross-sectional study design• Study area: 60 Woredas • Study Period: Nov-Dec 2010 source population: all expected
eligible Target population: eligible children
in sampled households• Sampling: : A two stage cluster
household survey – Systematic Random sampling of
woredas and random sampling of the EAs from the selected woredas
• To evaluate the overall national measles vaccination coverage of children 9-47 months of age post the SIA and routine EPI coverage among children 12-23 months of age
• To independently monitor the implementation of a set of selected BP for SIA
• To explore the relationship between the set of selected best practices and post measles vaccination coverage of children 9-47 months of age of the SIA in select Woredas
• To determine the proportion of target children that receive other interventions during the integrated measles SIAs campaign
Preliminary coverage survey resultRegions Measles
Coverage by maternal recall
Measles Coverage by Card
Measles Coverage by Either maternal recall or card
N Wted % N Wted % N Wted %
Amhara (n=405) 248 60.5 276 66.8 384 94.2
Oromia (n=963) 759 82.6 411 37.2 877 91.7
Somali (n=376) 363 97.2 155 36.3 365 97.3
SNNPR (n=526) 393 79.3 234 45.4 475 91.4
Harari (n=286) 217 72.7 202 70.3 272 91.7
Addis Ababa (n=269)
216 81.6 203 76.3 252 93.8
Dire Dawa (n=263)
234 89.2 115 47.8 241 91.2
Total (n=3088) 2430 77.5 1596 48.1 2866 92.7
Enhancing Routine Immunization Enhancing Routine Immunization through SIAsthrough SIAs
• 7 key areas identified in the planning phase and efforts made to maximize on RI strengthening:
1. Micro planning2. Training3. Logistics Management4. Advocacy and Social
Mobilization5. AEFI monitoring and
management6. Surveillance7. Monitoring and Evaluation
• Methods: used to evaluate the effect of SIA on RI- Focus Group Discussions (caretakers)- In depth interviews (health workers)- Observations (health facility + session)- Participation and feedback in post SIA review meetings
• Target:- Caretakers- Health workers
Effect of Measles SIA on the Effect of Measles SIA on the Routine System, EthiopiaRoutine System, Ethiopia
Regions
Addis Ababa Oromiya SNNPR SomaliPre-SIA Post SIA Pre-SIA Post-SIA Pre-SIA Post SIA Pre-SIA Post-SIA
Presence of a micro plan for EPI
50% 76.9% 98.8% 98.8% 100% 100% 60% 73.3%
Monthly monitoring of immunization coverage
58% 62% 83% 84% 55% 67% 33 % 53%
Monitoring chart up to date
50% 63% 35% 99% 100% 100% 60% 64%
Number of health facilities which had adequate functional cold chain
83% 100% 26% 22% 32% 14% 80% 80%
Number of health facilities which had adequate safety boxes
83% 92% 96% 99% 96% 100% 93% 100%
Number health workers who know the use of additional doses of measles immunization
75% 92% 46% 74% 76% 100% 27% 87%
Key Factors Contributing to SIA SuccessKey Factors Contributing to SIA SuccessSIA Component Major Elements of Success
Coordination •Task Force and subcommittee establishment at all levels with engagement of key partners
Micro planning and training
•Early start from Kebele level with administration involvement in the planning process•Identification of knowledge and skills gaps for emphasis in training•Practical and participatory methods approach•Development of pocket guide in local language•Pre-and post test and training evaluation for quality training
Advocacy and Social Mobilization
•Development of messages based on analysis of gaps and concerns of the community•Involvement of political leadership at all levels in advocacy•Utilization of diverse channels of communication including house to house canvassing for mobilization
Logistics • Distribution to all woredas from the federal level with pre planning of bundle logistics distribution
Monitoring and evaluation
•Daily review meetings•Intra- SIA monitoring (Daily SMS Reporting, RCM, Independent monitoring)
Key Challenges of the SIAKey Challenges of the SIASIA Component Challenges addressed in the second phase
Micro planning and Training
• Delays in translated materials (4 languages) resulting in late distribution to sub national level
• Finding accurate conversion factor for 9 to 47 months
Funds transfer • Delayed funds disbursement from central level to some regions due to late liquidation of funds
Implementation • Accurate screening of target age group
Logistics • Shortages of vaccines experienced in some zones
Monitoring and Supervision
• Poor quality of finger markers (utilize screening card for monitoring)
• Inability to effectively transmit daily coverage achievements to the next level intra campaign(Daily using SMS)
Next StepsNext Steps
• Finalize ongoing evaluationso Coverage surveyo Routine EPI strengthening (6 months follow up)
• Finalize documentation of the best practice SIA
• Maximizing on gains from the SIA to strengthen routine EPI
Conclusions from Best Practice SIA• Identification of country-specific BP for incorporation
in the micro planning and training • Emphasis on the best practices concept raised
commitment at all levels• Implementation of a best practice concept improves
resource allocation to most critical areas• Bottom -up planning from Kebele level with
engagement of HEWs, local administration and stakeholders
• Establishment and functionality of coordination structures at all levels
• Efforts were made to strengthen the routine system through the SIA which need to be sustained
AcknowledgementAcknowledgement
Ethiopia Federal Ministry of Health
Local Partners: CORE GROUP, L10K, IFHP