Accelerating Routine Immunization in Angola

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Accelerating Routine Immunization in Angola
Republic of Angola Ministry of Health

• 11 Meeting of The Task Force on
• Immunization in Africa (TFI)
• 2 - 5 December, Luanda, Angola

th
WHO
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Situation Analysis

• Insufficient access of population to health care
• 40 of health facilities destroyed by war or
  non-functioning
• Large distances to health centres
• Inefficiency of existing health facilities
• Missed opportunities for vaccination
• No outreach
• Inadequate of monitoring and use of information
  

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Situation Analysis cont

• General constraints
• Insufficient funds mobilized goals not matched
  with financial needs
• Lack of monitoring and supervision.
• Lack of training materials and guides.
• Distribution of vaccine, materials
• Function of cold chain.

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Angola DPT-3 coverage. July 2003 - children
under-1
DPT-1 70 DPT 3 45 Drop out 25
Without routine vaccination
lt 50
50 79
gt 80
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The Response

• Focus on municipalities Elaboration of plan for
  accelerating routine immunization
• Prioritization of 59/164 municipalities (75 of
  the population).
• Elaboration training, communication
  micro-planning materials
• Detailed micro-planning for involved districts
• Training of trainers (18 provincial and 59
  municipalities).
• Social communication and mobilization support.

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Municipalities selected for intensification of
routine immunization

• Size of population
• Availability of resources
• Minimum functioning of health facilities.
• Geographic distribution - at least 2
  municipalities in each province

municipalities selected
59 municipalities, population 12. 8 Million (75
total)
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Micro-planning

• Based on experience from polio/measles S.I.A.s
• Define health facilities geographically and
  population of responsibility.
• Localize target communities and schedule
  outreach.
• Estimate resources needed and budget.

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Training oriented to tasks

• Training of trainers
• 18 Provincial EPI supervisors
• 18 Provincial Mobilization supervisors
• 59 Municipal EPI mobilization supervisors
• Training of health facility and community people
• 1,981 vaccinators (5 days)
• 3,103 mobilizators (2 days)
• 26 theatre groups

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Supportive supervision

• Develop skills for formative supervision
• Scheduled
• Use check list for key issues
• Vehicles and per diem guaranteed
• Executed in cascade
• National supervise provincial level and a sample
  of mun. and health facilities
• Provincial supervise municipal level and a sample
  of health facilities
• Municipal supervise all health facilities

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Monthly coverage monitoring

• At all levels, beginning by municipal level
• Monthly meetings with Health Facilities
• DPT-3 children under-1
• TT-2 pregnant woman
• DTP-1 to DTP-3

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IEC and Mobilization

• Redesign immunization cards.
• Radio programmes spots in 7 languages
• Community Theatre
• Traditional leaders participation

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Financing vaccines and vaccination materials
now and for the future (in Million of US)
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Challenges

• Changing behaviour of personnel and
  administrations (passive to active)
• Solving communication and logistic problems
• Creating solid links between health facilities
  and communities
• Integrating other health interventions
• Creating sustainability

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Conclusions

• Sustained intensification of routine immunization
  at municipal level requires
• Strong and sustained support at central level to
  plan, implement and monitor activities and
  outcomes.
• Increased efficiency of the health network by
  overcoming resistance to change in the system
• Injection of five catalytic inputs
• a) Micro planning
• b) Supportive supervision
• c) Social communication
• d) Monthly monitoring coverage, cold chain
  function
• e) Regular feedback