Tools for SIAs and RI Social Mobilization

1. Tools for SIAs and RI Social Mobilization 12th Annual Measles & Rubella Initiative Meeting 10th-11th September, 2013 WB Mbabazi, RJ Davis, M Charles, A Patel

2. Where are we going?

3. Global Immunization Aspirations • Global Measles goals • By 2015 • Vaccination coverage: • Routine: >90% national level and >80% in every district • SIAs: > 95% in M, MR or MMR in every district. • Reported incidence: <5 cases of measles per million • Mortality reduction: 95% (compared to 2000 Nos) • By 2020 • Sustain 2015 goals • > 95% coverage with both the first and second routine doses of MCV (or measles- rubella-containing vaccine as appropriate) in each district and nationally. • GVAP mission

4. Major Challenges for Measles EliminationHave a communication Angle to the solutions Weak immunization systems Large outbreaks and changing age distribution Funding BBC Caption (6th May 2013) http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70133-6/fulltext

5. AMCROSS CONCEPTUAL APPROACH AND TOOLS For SIAs & RI promotion

6. Sustainable measles elimination programming Polio Eradication Measles control MNT Elimination Meningitis control YF control Influenza control Adapted from IMMUNIZATIONbasics Project

7. House-to-House Strategy: Leveraging SIAs experience into Routine Immunization • In SIAs, ARC has learnt that: • H2H canvassing reaches populations that are missed by traditional mass media, even in urban areas. • Data from 13 African countries (Bob 2012) showed that higher coverage are reached wherever H2H strategy was used • Cost per beneficiary averages $0.32 but can vary, being about $0.16 in cities compared to $0.57 in rural areas • Testing H2H Strategy in immunization defaulters: • Prevention: Baby tracking in Kilindi district of Tanzania • Correction: Defaulters tracing in Dar es Salaam & 3 selected cities in Uganda

8. 70% of them are from 10 Countries, using 2009-2011 JRF reported immunizations (in millions) Using H2H strategy to look for 20M infants who missed their MCV1

9. Top 10 Countries with DTP un & under-immunized children in 2012, AFRO Data Driven Selection of targeted countries and Districts

10. Where do the under- or un-immunized children live? • In Uganda • 80% of immunization defaulters live in 36 districts • URCS targeted 4 of 36 • Urbanized • Highest numbers • Testing the House-to-House canvassing strategy in defaulters tracing • 1st defaulters tracing week took place in first week of July, and was integrated with the UNICEF supported “Family Health Days”. Arua Lira Greater Kampala (K’la & Wakiso)

11. Where do the under- or un-immunized children live? • In Tanzania • 80% of immunization defaulters lived in 51 districts in 2009 and 70 districts in 2011 • National plan for correction of missed immunizations as part of RI coverage improvement plan implemented since 2009 • Progressively more districts attained 80% DTP-3 coverage but the Greater Dar es Salaam did not change • TRCS supported to use the House-to-House strategy in turning fortunes in Dar

12. Improving DTP-3 trends but poor performance localized 2009 2010 Below 80% 2011 80% to 89% 90% + Greater Dar (3 Districts) remained underperforming x 3yrs

13. Interventions description Defaulters Tracing • Campaign Approach • Volunteers conduct Quarterly H2H visits to all H/Holds • Screening for RI defaulters • Remind defaulters • Nudge defaulters to correct missed doses Baby Tracking • Community-based volunteers • Identify and register all newborn babies • Conduct House-visits to all families with infants • Remind them of the next scheduled RI dose • Information on the next planned EPI sessions

14. Delays in Project Start denies complete outputs of H2H strategy in RI • In Uganda AMCROSS • Was drawn into the vaccine supply chain crisis for more than 6 months. Testing our advocacy and networking credentials • First H2H tracing for defaulters took place in July, 2013 • Reached 50% of Households in selected 4 districts • Found 79,316 children < 5yrs who have incomplete immunization and supported 70% of them to update their immunizations • In Tanzania: • Translation of project proposals into implementation plans delayed (Alignment with RED scale up plans, procuring buy in from the 3-layers of government and development of M&E tools) • First H2H tracing of EPI defaulters planned for 15th to 21st Sep

15. SIA tools (Including Social Mob) can be used to strengthen Routine Immunization SIA input Sustainable Elimination RI Follow-up Immunization program needs, priorities ooooops, Where was Social Mobilization?

16. Conclusions • There exists monitoring infrastructure to tell us where unimmunized children are or live • MRI partners can advocate for routine MCV coverage improvements, in selected high-priority countries • Each individual MRI partner can do small routine MCV promotional interventions in the high-priority countries contributing the most un and under-immunizations • Too early to tell, BUT H2H canvassing can find defaulters and provide them reminders, incentives and structures for correction of missed RI doses • Advocacy and social Mob stream of interventions developed and used in SIAs that strengthen RI needed

17. Anne Ray Charitable Trust Thank You