Major causes of low immunization coverage

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Increasing immunization Coverage Reaching
Every District or The Access approach
Presentation to the NESI Training Meeting,
Nairobi, 9 11 December 2002 Dr. Rose
Macauley WHO/AFRO
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OUTLINE OF PRESENTATION

• Regional vaccination coverage objective
• Current status of vaccination coverage
• Progress towards achieving the regional objective
• The access approach

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Vaccination Coverage Objective of Regional EPI
Strategic Plan GAVI

• To achieve at least 80 vaccination coverage in
  all the districts in 80 of the countries by 2005
• In the context of quality and sustainable
  services.

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Global situation

• Un-reached children
• 36 million globally
• 12 million in Africa
• District disparity reaching 80 coverage in all
  districts
• 27 of developing countries have achieved
• 7 of countries in AFR0 have achieve
• Disease control or eradication goals cannot be
  achieved/sustained with low routine coverage

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Current Regional Situation (2)

• DPT3 coverage trend 2000 to 2001
• Increase 19 countries (42)
• Decrease 20 countries (44)
• District performance at least 80 DPT3 coverage
  
• 3 countries (7) in all districts (Gambia,
  Mauritius, Seychelles)
• 7 countries (16) in 50 of the districts

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Progress towards 80/80 Goal 2001

• Districts achieving at least 80 DPT3 coverage
• 3/46 countries all districts (Gambia, Mauritius,
  Seychelles) but these are very small
  countries
• 2/46 countries 80-99 of the districts
• 2/46 countries 50-79 of the districts
• 31/46 countries 0-49 of the districts
• 8 countries data unavailable or not usable

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Reported DPT3 Coverage African Region, 2000 2001
2001
2000
ND
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Reported DPT3 Coverage by Epidemiological Block -
Africa Region, 1996-2001
Still a long way to go
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In an effort to address this problem of low
vaccination coverage, partners have identified a
approach, called the Access Approach or
Reaching Every District (RED) Approach.
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Strategies

• District focus
• Assessment and problem solving
• Planning, budgeting, implementation, monitoring
• Adequate funding and capacity for implementation
• Annual milestones
• Prioritizing districts by un-immunized children

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Operational components (1)

• 5 operational components
• Re-establishing outreach vaccination
• Supportive supervision
• Links between community and service
• Monitoring for action
• Planning management of resources.

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Operational components (3)

• Re-establishing outreach vaccination for
  under-served communities
• Regular
• From fully operational and adequately equipped
  health facility
• By trained and motivated staff
• Ensuring appropriate transport
• Note Offer an integrated package

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Operational components (4)

• Supportive supervision to build capacity for safe
  and high quality immunization services
• Regular
• Combine with on-site training
• Offers opportunity to integrate with other
  interventions (IMCI, RBM, deworming, Vit A, etc.)
• Linking the community and health service to
  ensure regular and meaningful interactions
  between them
• Regular meetings consultations, monitoring
• Use of community structure

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Operational components (5)

• Monitoring for action
• Critical review of data systems
• Availability of timely and quality data
• Strengthen monitoring systems
• Data to direct planning and managerial action at
  district level
• Use of tools for continuous self monitoring at
  health facility level (wall charts, mapping
  populations served)

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Operational components (6)

• Planning and management of resources
• Detailed plan at all levels to include human and
  financial resources requirements
• District level plans to include management of
  resources
• Country Financial Sustainability Plan
• Current situation
• Future funding prospects (GAVI definition)

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Putting the strategies into action at the various
levels

• District detailed POA to include all 5
  components for reaching every child
• Sub-national focus for district capacity
  building for training, supportive supervision,
  monitoring, planning and implementation

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Putting the strategies into action at the various
levels

• National focus on coordination and technical
  assistance (national international)
• Regional focus for technical assistance and
  building capacity at national level monitoring
  evaluation.

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Putting the strategies into action

• Milestones for DPT3 coverage in all districts
• 60 by 2003
• 70 by 2004
• 80 by 2005
• Phased implementation, prioritizing districts
• lowest coverage
• highest number of unvaccinated/partially
  vaccinated children
• Implement in a phased manner not neglecting
  well-performers to avoid regression

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Linking with other health sector priorities

• Health sector priorities
• MI
• RBM
• IMCI
• IDS
• Partners strategies
• WHO Beyond Polio (NID, AFP, Lab)
• UNICEF Immunization Plus

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The problem - barriers to reaching every district

• Low quality of service
• Inadequate training and supervision
• outreach services, logistics and supply
  unreliable
• links with the community not systematic
• Global goal not reflected in financial
• commitment
• commitment to goals not yet matched
• by sustained financing commitments

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The problem - barriers to reaching every district

• Inadequate monitoring system
• national immunization coverage data
• unreliable
• national data does not show large
• district disparities
• Lack of district micro-planning
• national plans not reflected in
• district plans

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Challenges Eroded Gains due to vaccine
stock-out, 2001
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Challenge related to the Big 4 countries

• Comprise of 40 target population in the region
• Still lt50 DPT3 vaccination coverage
• huge left out target populations
• EPI environment
• post war weak district health system
• Special substantial support is needed

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Some examples of interventions in the region to
improve access and thereby improve coverage
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Couverture vaccinale DTC3 2001
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Couverture vaccinale DTC3 2001 au Bénin
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Reported DTP coverage in 2001 by district,
Madagascar
lt60
60-69
70-79
gt80
DTP 1 coverage
DTP 3 coverage
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Social Mobilization network-Ethiopia
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Social Mobilization network --Angola
MoH
LEGION DE MARIA
CICA
SCOUT
CORE
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Thank you!