The Expanded Program on Immunizations – EPI

1. Supporting Routine AND Supplementary Immunization Activities in STOP The Expanded Program on Immunizations – EPI

2. The “RE” –Emphasis on Routine • 2009 external evaluation of major barriers to interrupting poliovirus transmission (WHO) • RI is weak across re-infected countries leading to inability to quickly control importation • Recommendations to WHO D.G. • Systematic attention by the polio eradication programme to strengthening RI systems • Appropriate balance needed between SIAs and RI services across endemic countries • Coordination must be improved between partners to ensure both RI and SIA are conducted optimally • Capacity in social mobilization, planning, management and monitoring should be strengthened

3. Together, Routine & Supplementary Activities Can Most Quickly Decrease Deaths Annual measles deaths “Catch-up” + Constant routine Constant routine Strengthen routine only Strengthen routine + “catch-up” + “second opportunity” Year Note: routine strengthening assumes 2.5% annual improvement in routine immunization coverage until 95%

4. Key areas of RI + SIA overlap • Social mobilization activities • Planning • Target population identification • Cold chain • Surveillance • Human resources • Vaccine safety • Waste management • Management teams

5. Social mobilization • What you can do • Have campaign materials emphasize • Routine services protect against other VPDs • Location of RI sessions • Routine vaccine schedule • When you can do it • Training materials development • Health worker training • Campaign monitoring • Meetings with community social mobilization committees

6. Don’t forget to come back next month for your routine immunization!

7. Planning • What you can do • Plan campaigns with minimal interruption to routine program • Ensure RI supervision checklists exist • Check that microplans exist for SIA and RI • Develop systems that benefit RI: update maps, … • When you can do it • National level planning meetings • Facility/district staff meetings • Facility visits

8. Target population identification Look at this map with the high risk areas in blue! • Define targets • Areas of low coverage • High risk areas/pops • Areas of continued disease transmission • Refer high risk/zero dose areas to RI for follow up

9. Communities • What you can do • Check vaccination cards • Check if health worker has given messages on RI • Location of vaccination post • Reminder about next vaccine • Reminder about any missed vaccinations • When you can do it • Campaign monitoring

10. I’ll take this opportunity to promote routine and supplemental immunizations!

11. Cold chain I’m taking note of your broken cold chain equipment. Let’s work with the district to get this fixed! • What you can do • Check functioning of each freezer & refrigerator • Check that regular monitoring is occurring • Verify ice pack conditioning • Report back to management team • When you can do it • Campaign monitoring visits • Health facility visits during planning, training and surveillance visits

12. Vaccine management • What you can do • Check vaccine stock records • Check condition of all vaccines • VVM stage • Ensure HW knows how to interpret • Discuss numbers & stock with HW • Report stockouts to district • When you can do it • Health facility visits

13. Let’s talk about ways to improve stock management to reduce vaccine wastage.

14. Surveillance system • What you can do • Check awareness of health workers on • How to handle suspected cases • What is reportable? Measles, AFP, … • Availability of case investigation forms/manuals • Functionality feedback loop from labs to facilities • When you can do it • Health facility visits • National lab visits • Meetings with district officials

15. Health workers • Many RI health workers work in campaigns • What you can do • Provide motivation in your interactions • Train, supervise & discuss RI issues Great work!

16. Vaccine safety and waste management • What you can do • Check awareness of health workers on • Proper vaccination techniques • Handling of AEFI • Availability of AEFI plans for all vaccines • Availability and proper use of incinerators / pits • Check proper syringe disposal techniques • When you can do it • Health facility visit • Immunization sessions

17. What a brave boy you were! I need to put this used needle in the safety box.

18. Management teams = Decision makers for SIA + RI • In many locations • District health management teams manage SIA as well as RI • Convey messages • High routine coverage lengthens the period between campaigns • Updates on weak areas which affect both activities • cold chain • target populations • surveillance

19. The maps do not include the slum areas along the river. We must update them!

20. Opportunities to emphasize RI • Social mobilization planning • Emphasize routine messages • District level campaign planning • Emphasize sharing of maps and action plans • Campaign training • Offer training in other aspects of EPI • Surveillance system interactions • Lend support to surveillance of other diseases

21. Opportunities to emphasize RI (cont) • National/District decision-maker meetings • Report on problem areas • Ensure emphasis on RI messages • Health facility visits • Cold chain • Vaccine management • Health worker knowledge • Monitoring / Community visits • Vaccination cards • Awareness of RI

22. Practical reminders when giving RI messages • Ideally, EPI programmes include both RI and SIA activities • However, different partners may own different activities • Evaluate the country situation • Be in line with the in-country structure

23. Resources • STOP folder – 9 Opportunities to Enhance Synergy between Supplemental Immunization Activities and Routine Immunization Services • Local EPI Director & WHO office • http://www.who.int/health_topics/immunization/en • Immunization Essentials: a Practical Field Guide • STOP point of contact

24. Identify those of you with EPI experience in balancing RI & Polio/Measles Quickly Match with 1 or 2 persons in the room with less/no experience Spend 10 minutes discussing in group what you can do in polio/measles assignments to strengthen RI We will review ideas as a group Discussion Exercise: Identify ways in which STOP members can utilize SIA/Surveillance and Routine Immunization activities

25. Your Ideas for how to promote Routine EPI during your assignments