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Strengthening Routine Infant Immunization in EMR Partners for Measles Advocacy February, 2007

Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization. Strengthening Routine Infant Immunization in EMR Partners for Measles Advocacy February, 2007.

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Strengthening Routine Infant Immunization in EMR Partners for Measles Advocacy February, 2007

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  1. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Strengthening Routine Infant Immunization in EMR Partners for Measles Advocacy February, 2007 Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  2. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Trends in DTP3 and MCV1 Coverage in the EMR, 1994-2003 Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  3. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Reported Routine Immunization Coverage, EMR0, 1994-2003 Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  4. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Reported Infants Routine Immunization Coverage (2003) 90% Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  5. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Distribution of Unvaccinated Infants in EMR, 2003 AFG Others YEM IRQ SUD SOM PAK Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  6. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Key Constraints to Raising EPI Coverage • Insecurity (AFG, SOM, SUD, IRQ) • Poor management • Ongoing polio activities • Weak Health Systems • Human resources • Logistics • Financial resources ???? Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  7. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization REGIONAL PRIORITY 2003Increase 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 Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  8. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Immunization Services Strengthening 05/2001 $7,255,000 Palestine 02/2001 $32,508,000 Bahrain 05/2001 $4,342,000 10/2001 $8,968,500 05/2002 $271,000 05/2002 $3,393,500 Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  9. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Reported Routine Immunization Coverage, EMR0, 1994-2005 Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  10. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Reported DPT3 Routine Immunization Coverage in Priority countries 2002-2005 2002 2003 2004 2005 AFG DJI IRQ PAK SOM SUD YEM Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  11. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization Impact of RED on District Performance (2002-2005) % of districts AFG DJI IRQ PAK SUD YEM SOM DPT3<50% 50<DPT3<79% DPT3>=80%

  12. Program Management Reform Sudan (2001 – 2005) • Governance tools designed & strengthened; • Strategic planning addressing all program components/ DC • Effective coordination • Knowledge & Information (strong database and M&E system) • Resource development; • Capacity building (TOT training 100%, Refresher 70%, SOPs) • Rehabilitation of the infrastructure (Cold chain, communication & Transport > 2 million $) • Mobilization of local resources (using GAVI money) • Service delivery; • Addressing Access & Utilization issues (RED approach) • Quality Immunization & safety issues • Integration? (District Health System)

  13. Components of RED in Sudan • Re-establishment of outreach vaccination… • Supportive supervision… • Link between community and service… • Monitoring for action… • Planning and management of resources…

  14. Re-establishing Outreach Vaccination Services in Sudan

  15. 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.

  16. 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…

  17. 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)…

  18. 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…

  19. Monitoring for action…2 • Conduct regular (monthly “State” and quarterly “Federal”) review meetings: • Opportunity for on-site training… • Problem solving… • Feedback…

  20. Planning and management of resources…1 • Set up teams (Federal/ State/ Locality): • Technical support and need assessment… • 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:

  21. Prioritization for implementation

  22. Operational considerations for implementation of RED approach: • Effective and efficient logistics management which includes; • Vaccine management • Cold chain management • Maintenance management for all equipments

  23. Group (1): Good performing States, Achievements 2002 - 2005 Gezira River Nile Blue Nile White Nile Gedarif S. Kordofan

  24. Group (2): Medium Performing States, Achievements 2002 – 2005…1 N. Kordofan Sennar Red Sea Northern Kassala W. Kordofan

  25. Group (2): Medium Performing States, Achievements 2002 – 2005…2 Khartoum S. Darfur W. Darfur N. Darfur

  26. Group (3): low performing States, Achievements 2002 - 2005 Upper Nile Bahr Algabal Unity Upper Nile Jongli Jongli W. B. Gazal E. Equatoria N. B. Gazal

  27. EPI Performance Sudan, 2002- 2005 DTP3 in2002 DTP3 in 2003 DTP3 in 2004 DTP3 in 2005 > 80% 50 – 79% < 50%

  28. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization SummaryStrengthening Routine EPI in the EMR • Impact of GAVI input: • SUD, YEM & AFG ++++ • PAK & DJI ++ • SOM & sSUD: ?? Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  29. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization SummaryStrengthening 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 +++ Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007

  30. Eastern Mediterranean Regional Office Vaccines Preventable Diseases & Immunization GIM Meeting, New York, USA, 13-15 February 2007

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