strengthening routine infant immunization in emr partners for measles advocacy february, 2007
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Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization. Strengthening Routine Infant Immunization in EMR Partners for Measles Advocacy February, 2007. - PowerPoint PPT PresentationTRANSCRIPT
Strengthening Routine Infant Immunization in EMRStrengthening Routine Infant Immunization in EMR
Partners for Measles AdvocacyPartners for Measles Advocacy
February, 2007February, 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Trends in DTP3 and MCV1 Coverage in the Trends in DTP3 and MCV1 Coverage in the EMR, 1994-2003EMR, 1994-2003
20
40
60
80
100
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Year
Perc
ent c
over
age
DTP3/OPV3
Measles
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Reported Routine Immunization Reported Routine Immunization Coverage, EMR0, 1994-2003Coverage, EMR0, 1994-2003
20
40
60
80
100
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Year
Perc
ent c
over
age
DTP3/OPV3MeaslesHBV 3
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Reported Infants Routine Immunization Coverage Reported Infants Routine Immunization Coverage (2003)(2003)
0102030405060708090
100
AFG
BAH DJI
EGY
IRA
IRQ
JOR
KW
T
LEB
LIY
MOR
OMA
PAK
PAL
QAT
SAA
SOM
SUD
SYR
TUN
UAE
YEM
90%
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Distribution of Unvaccinated Infants in EMR, 2003Distribution of Unvaccinated Infants in EMR, 2003
4.0%
50%7%
7%
9%9%
14%
PAK
IRQ
AFG
SOM
SUD
YEMOthers
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
• Insecurity (AFG, SOM, SUD, IRQ)• Poor management• Ongoing polio activities• Weak Health Systems
– Human resources– Logistics
• Financial resources ????
Key Constraints to Raising EPI CoverageKey Constraints to Raising EPI Coverage
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
REGIONAL PRIORITY 2003REGIONAL PRIORITY 2003Increase routine coverage in the 6 priority countriesIncrease routine coverage in the 6 priority countries
Capacity development• RED approach• Vaccine management• Financial sustainability planning
Targeted technical assistance • RWG-GAVI• SSAs & STPs
Monitoring– District-level coverage – Frequent country visits
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Palestine
Bahrain
05/2001$7,255,000
02/2001$32,508,000
10/2001$8,968,500
05/2001$4,342,000
05/2002$3,393,500
05/2002$271,000
Immunization Services Strengthening
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Reported Routine Immunization Reported Routine Immunization Coverage, EMR0, 1994-2005Coverage, EMR0, 1994-2005
20
40
60
80
100
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year
Perc
ent c
over
age
DTP3/OPV3MeaslesHBV 3
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Reported DPT3 Routine Immunization Coverage in Reported DPT3 Routine Immunization Coverage in Priority countries 2002-2005Priority countries 2002-2005
0
10
20
30
40
50
60
70
80
90
100
AFG DJI IRQ PAK SOM SUD YEM
2002 2003 2004
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
2005
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Impact of RED on District Impact of RED on District Performance (2002-2005)Performance (2002-2005)
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2002
2005
2002
2005
2002
2005
2002
2005
2002
2005
2002
2005
2002
2005
AFG DJI IRQ PAK SUD YEM SOM
DPT3<50% 50<DPT3<79% DPT3>=80%
% o
f dis
tric
ts
Program Management Reform Sudan (2001 – 2005)
1. Governance tools designed & strengthened;1. Strategic planning addressing all program components/ DC2. Effective coordination3. Knowledge & Information (strong database and M&E system)
2. Resource development;1. Capacity building (TOT training 100%, Refresher 70%, SOPs)2. Rehabilitation of the infrastructure (Cold chain, communication
& Transport > 2 million $)3. Mobilization of local resources (using GAVI money)
3. Service delivery;1. Addressing Access & Utilization issues (RED approach)2. Quality Immunization & safety issues3. Integration? (District Health System)
Components of RED in Sudan
1. Re-establishment of outreach vaccination…
2. Supportive supervision…
3. Link between community and service…
4. Monitoring for action…
5. Planning and management of resources…
Re-establishing Outreach Vaccination Services in Sudan
1153 1148
20593121
4048 3925240
205
410 828
10798650
1000
2000
3000
4000
5000
6000
7000
2002 2003 2004 2005
Fixed sites Outreaches Mobile units
Sustaining Outreach services…
– Deliver immunization services on basis of periodic contact to people with limited or no access
– Community participation is vital…
– Campaign and/or outreach depending on operational constraints like distance, population density and terrain.
Supportive supervision…
• Planned, joint activity…• On- site training…• Use DQS as a tool (2005)…• Performance was carefully
measured using quality indicators…
• Good performance was acknowledged and rewarded…
Link with community…• Advocacy meetings to revitalize the political
commitment/ ICC…
• Establishing EPI friends Associations in some states (NIDs’ volunteers)…
• Use existing community structure to trace & retrieve the defaulters…
• Use of polio campaigns to advocate for routine immunization/ IEC…
• Feedback to community (still Ad Hoc)…
Monitoring for action…Sudan
• Use maps, graphs and charts to;
– Map vaccination coverage and drop-out rates by health facility & each district…
– Follow trend of performance of each health facility & each district.
– Send regular feedback & feed forward…
Monitoring for action…2
• Conduct regular (monthly “State” and quarterly “Federal”) review meetings:
– Opportunity for on-site training…
– Problem solving…
– Feedback…
Planning and management of resources…1
Set up teams (Federal/ State/ Locality):
1. Technical support and need assessment…
2. Familiarization of participants on the RED approach and its implementation…
District planning workshops; the 5 steps were followed to develop the districts micro-plans…
Rational use of polio infrastructure/ experience…
The 5 steps:
Prioritization for implementation Prioritization for implementation
Operational considerations for implementation of RED approach:
• Effective and efficient logistics management which includes;
– Vaccine management
– Cold chain management
– Maintenance management for all equipments
Group (1): Good performing States, Group (1): Good performing States, Achievements 2002 - 2005 Achievements 2002 - 2005
8892 89 100
0102030405060708090
10081
86 86 85
0102030405060708090
10096 94 98 95
0102030405060708090
100
91 89 85 89
0102030405060708090
100
White Nile85.7 8680
97
0102030405060708090
100
S. Kordofan
Blue NileGezira River Nile
100 98 100 97
0102030405060708090
100
Gedarif
Group (2): Medium Performing States, Group (2): Medium Performing States, Achievements 2002 – 2005…1 Achievements 2002 – 2005…1
NorthernW. Kordofan
Red SeaN. Kordofan Sennar
Kassala
54.4
9485
92
0102030405060708090
100
65
95 93 99
0102030405060708090
100
64.6
7584 84
0102030405060708090
100
41
8288 84
0102030405060708090
100
41
8288 84
0102030405060708090
100
68.173 76 81
0102030405060708090
100
Group (2): Medium Performing States, Group (2): Medium Performing States, Achievements 2002 – 2005…2 Achievements 2002 – 2005…2
N. Darfur
S. DarfurKhartoum
W. Darfur
44.5
55.463 65
0102030405060708090
100
36.3
45.451
61
0102030405060708090
100
50
8676
70
0102030405060708090
100
76
888177
0102030405060708090
100
Group (3): low performing States, Group (3): low performing States, Achievements 2002 - 2005 Achievements 2002 - 2005
Jongli
E. Equatoria
Upper Nile
Bahr Algabal
Unity
W. B. Gazal
45.5
7989
48
0102030405060708090
100
34
6768
44
0102030405060708090
100
34
726157
0102030405060708090
100
9
27219
0102030405060708090
10031
10080
50
0102030405060708090
100
2
54
25
3
0102030405060708090
100
0
14118
0102030405060708090
100
Upper Nile
Jongli
N. B. Gazal
EPI Performance Sudan, 2002- 2005
DTP3 in 2003DTP3 in 2002
DTP3 in 2004
> 80% 50 – 79% < 50%
DTP3 in 20050
20406080
100
2002
2003
2004
2005
OPV3 DPT3 BCG Measles
SummarySummaryStrengthening Routine EPI in the EMRStrengthening Routine EPI in the EMR
• Impact of GAVI input: – SUD, YEM & AFG ++++– PAK & DJI ++ – SOM & sSUD: ??
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
SummarySummaryStrengthening Routine EPI in the EMRStrengthening Routine EPI in the EMR
• Lessons learned – PAK:
• Channeling financial resources to operational level • Devolution• Rigidity in financial rules
– DJI: Human resources issue– SOM & sSUD:
• Insecurity• Poor coordination between partners
– ALL: • Health system barriers not/poorly addressed• End of 5 years ISS support +++
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
GIM Meeting, New York, USA, 13-15 February 2007