Editor's Note:
In June 2003, UNICEF and GAVI (The Global Alliance for Vaccines & Immunization) held regional workshops in Istanbul, Johannesburg, and Bangkok to address key issues in communication for immunisation. Participants included communication and immunisation specialists, Expanded Programme on Immunization (EPI) managers, and health educators from governments and GAVI partners working in more than 40 countries. The workshops addressed such issues as communication for immunisation safety, advocacy for financial sustainability, social mobilisation, communication planning, communication to improve district-level coverage, facing the media, communication strategies in response to Adverse Events Following Immunization (AEFIs) and to build public trust in immunisation, and immunisation of hard-to-reach groups, among others. A free CD-ROM draws together key presentations, discussions, tools, topics, and recommendations; please see ordering information below.
Summary provided by the presenter
Primary (or routine) immunization is facing many challenges to reach all children in difficult access areas as well as to ensure that children start and complete the vaccination series. Since differences in coverage within countries are not usually evident from national level statistics, it is particularly important to use district-level data to plan and implement activities. The "RED" approach includes a combination of strategies to assist in improving primary immunization at the district level, including: re-establishing outreach services, improving supportive supervision, strengthening community links with service delivery, improving monitoring and use of data for action, and increasing planning and management of resources.
The presentation "Reaching Every District" describes each of the RED components in more detail. It includes examples of how various partners, particularly those supporting or working at district and/or community levels, can apply the RED approach to improve primary immunization.
Full presentation
Background
- GAVI goal for 2005: reach 80% coverage with DPT3 [diphtheria, pertussis tetanus - third dosage] in 100% of districts in 80% of countries
- Too many children are left out, never reached by primary (routine) vaccination
- High drop-outs, impossible to reduce without improved service delivery and communications
- In the same country, high national coverage can hide big differences between districts
- Equity in services, sustainability
Immunization Challenges
- Increase routine coverage and quality with existing vaccines
- Reduce mortality due to all vaccine-preventable diseases and eradicate polio
- Mobilize sustained national financing
- Assure immunization works in reformed context of integration, decentralization, and privatization
- Use immunization as vehicle for other population-based interventions and reaching the unreached
Five operational components needed to "Reach Every District"
- Re-establishment of outreach services
regular outreach for communities with poor access
- Supportive supervision
on site training by supervisors
- Community links with service delivery
regular meetings between community and health staff
- Monitoring and use of data for action
chart doses, map population in each health facility
- Planning and management of resources
better management of human and financial resources
Resume outreach vaccination activities means...
- Regular outreach (usually monthly) - planned and communicated with communities
- Appropriate logistic support (transportation, cold chain)
- Trained and motivated staff
- Flexibility to adjust to specific communities
Supportive supervision
- Different from "tourist visits"
- Supervision tools
- Clear supervision goals to help health staff solve problems
- Combine with on-site training
- Opportunity to integrate other health interventions (Nutrition, IMCI [Integrated Management of Childhood Illness], Malaria...)
Monitoring for action means...
- Proper use of EPI monitoring tools
- Indicators include: Coverage, completeness, timeliness, quality of data
- Use of data to improve planning and management
- Use of tools and feedback for continuous self monitoring at health facility level (wall charts, mapping populations served)
Planning and management of resources needed at district level
- Details of human and financial resources needed (micro planning)
- Material resources needed (logistics plans)
- Sustainability aspects
- Current situation
- Future funding prospects
- Partners commitment (ICC [Immunization Coordinating Committee])
- Community awareness and social mobilization
Suggested Partner Actions: Working at district level
- Disseminate and utilize tools and processes with partners (e.g. actively participate in ICCs and communication sub-committees involving NGOs and partners at district levels)
- Consider mechanisms like MOUs [Memoranda of Understanding] and "social contracts" with MOHs [Ministries of Health] to become more involved in service delivery (advocacy and mobilization)
- Use health sector reform/decentralization as opportunity for greater NGO and district-level involvement
- Better monitoring to support immunization improvement and demonstrate contribution at district level (monitoring drop-outs, capacity building, self-monitoring)
Click here for an overview of the June 2003 Communication for Immunization Workshops in Istanbul, Johannesburg, and Bangkok.
For more information, or to request a free copy of the CD-ROM on which this presentation is featured, contact:
Erica Kochi
ekochi@unicef.org
OR
Gina Darcin
gdarcinstlouis@unicef.org
UNICEF
UNICEF's Immunization website
