Reducing dropout rates

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Reducing drop-out rates

• The Côte dIvoire experience

Dr C. Anderson Koua National EPI Manager
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Cote dIvoire

• Area 322 600 km²
• Population 16 938 232
• lt 1 Year 663 248
• Health Regions 16
• Heath Districts 61

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Baseline

• Observed decline in overall routine EPI
  performance
• Indicators in 1994 were as follows
• DPT3 coverage 41
• Drop out rate DPT1/DPT3 35
• Districts with DPT3gt50 13
• Revitalization of EPI done through
• Political commitment at highest level
• Creation of EPI Executive Directorate
• Allocation of adequate resources

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Addressing high drop-out rates (steps)

• Priority problems identified among which very
  high drop out rates for DPT1/DPT3 (15 - 67)
• main causes of high drop-out
• Stopping/irregular outreach or mobile
  immunization strategies.
• Inadequate immunization schedules
• Inadequate follow-up of children immunized during
  fixed and outreach strategies (repeat of DPT1...)
• missed opportunities.

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Steps -

• Field visits /discussion with District Medical
  Officers using a guide to reach a consensus on
• Realistic objectives to reach
• Adequate immunization strategy
• Activities to implement to reduce drop-out rates
  with existing methods
• Monitoring indicators
• DPT3
• Drop-out rates for DPT1/DPT3

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Steps cont ...

• Follow-up of children immunized during outreach
  and mobile strategies by using ordinary copy
  books for all the teams
• Monthly monitoring of immunization coverage,
  surveillance and cold chain
• at service delivery level
• at district level
• at national level
• Follow-up and evaluation meetings
• Three times a year (May, October and December)
• Follow-up of immunization and surveillance
  activities
• Identification of obstacles and adoption of
  corrective measures for drop-out rates

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Steps cont ...

• At operational level
• Standardization of data collection forms
• Training of vaccinators and surpervisors
• Involvement of management committees (COGES) and
  other organizations from the community.
• For census, mobilisation and active research
• Developement/rationalization of outreach and
  mobile strategies
• immunization schedules developed with community
  participation
• Consensus reached on timing of immunization
  sessions

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Trend of Drop-out rate and DPT3 coverage 1994 to
2000
Source DEPEV/MSP
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Increased No. Of Health Districts with DPT3
coverage above 50 from 1994 to 2000
Source DEPEV/MSP
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Trend of Imm. Cov. DPT3 TT2 1994 to 2000
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Conclusion

• These achievements were made possible through
• Consensus reached with all stake holders at
  operational level on
• realistic objectives set based on existing
  capacities at op . level
• Identification of key problem(s) and appropriate
  strategies, and relevant activities that do not
  require additional costs
• Consensus reached with the community
• Immunization schedule
• Their implication on the immunization activities
• Monitoring at all levels
• Involvement of partners