Integrated Measles Best Practice SIA 2010/2011

1. Integrated Measles Best PracticeSIA 2010/2011 Experience from Ethioipia Global Measles and Rubella Meeting, 15-17 March 2011, Geneva

2. Outline • Background • Measles coverage and epidemiological situation • Ethiopia SIA Experience • SIA implementation/achievement • SIA evaluation • Opportunities and challenges

3. Ethiopia: Background Federal 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

4. Reported Measles Cases and Measles Coverage- 1990-2009, Ethiopia Best practice 2010 Catch Up 2002 -2004

5. Measles Outbreaks - 2010 Vaccination status of confirmed measles cases. January – Dec 2010 Confirmed Measles cases January - Dec 2010

6. Measles 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

7. Pre-Identified SIA Best Practices Micro planning and Training Emphasis on Kebele level planning with identification of hard to reach and difficult populations Participatory approach in training . Advocacy 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 Coordination • 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 Logistics • Required logistics available pre SIA with initiation of distribution 3-4 weeks before implementation • Flexibility in distribution mechanisms including transport fleet for emergency distribution

8. Pre – Identified SIA Best Practices Monitoring and Evaluation Resource Mobilization Significant Government contributions :- .017 cost per child High level cooperation between EPI partners Engagement of partners at all levels: Human resources, transport, social mobilization, logistics • 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

9. Implementation of Best Practice Integrated Measles SIA

10. Funding for 2010/11 Measles SIAs

11. 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

12. Launching Activities

13. Implementation

14. SIA Administrative Coverage, Ethiopia, 2010-11 >=95% OPV Coverage Measles Coverage 90-94% 80-89% National coverage 97% National coverage 106%

15. Independent Monitoring Assessment of Woreda Performance, Ethiopia 2010 Source of data: Post SIA Independent monitoring, 38 6Woredas (52%) sampled Note: Poor quality finger markers compromised the independent monitoring process in several areas

16. Evaluation of the Ethiopian measles SIAs Methodology Objective of the Survey 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 • 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

17. Preliminary coverage survey result

18. Enhancing Routine Immunization through SIAs • 7 key areas identified in the planning phase and efforts made to maximize on RI strengthening: • Micro planning • Training • Logistics Management • Advocacy and Social Mobilization • AEFI monitoring and management • Surveillance • 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

19. Effect of Measles SIA on the Routine System, Ethiopia

20. Key Factors Contributing to SIA Success

21. Key Challenges of the SIA

22. Next Steps • Finalize ongoing evaluations • Coverage survey • Routine EPI strengthening (6 months follow up) • Finalize documentation of the best practice SIA • Maximizing on gains from the SIA to strengthen routine EPI

23. 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

24. Acknowledgement Ethiopia Federal Ministry of Health Local Partners: CORE GROUP, L10K, IFHP