Launched in 2001, Reaching Every District (RED) is a World Health Organization (WHO) strategy of decentralised capacity building to address common obstacles to increasing immunisation coverage, with a focus on planning and monitoring. In this 31-slide PowerPoint presentation (delivered at the RED workshop in Durban, South Africa, May 10-12 2006), Serge Ganivet of WHO/Harare begins by exploring the purpose of district-level micro-planning as a strategy for achieving RED, by helping to:

• produce high-quality micro plans
• increase coverage and reduce drop outs
• identify and address the unreached
• regularly use data to monitor and follow up at all levels

Ganivet begins by stressing that strong commitment to the various responsibilities for meeting RED will be needed at national, district, and health facility (HF) levels. This paper focuses on district-level micro planning using the RED approach, which includes the following components: 1) Re-establishing outreach services, 2) supportive supervision, 3) linking services with communities, 4) monitoring and use of data for action, 5) planning and management of resources. Communication comes into play in several of these processes. For example, to help link services with communities, advocacy for the benefits of immunisation can be accomplished through interaction with the media and local leaders (national level); HF staff can be supported in establishing regular dialogue with the community (district level), and meetings with community leaders and volunteers can be set up (HF level).

As Ganivet explains, micro-planning is a methodology for achieving 100% coverage in what he describes as a "defined health center zone". In such an area, the catchment area is defined, the population of each village/community in the health zone is known, the distances between villages/communities and the health centre are known, the current vaccination situation has been analysed, and the standards for deciding when to use outreach and mobile strategy are defined. In this context, the micro-planning approach is initiated in a workshop setting; however, most of the work is done individually by the health centre staff with support and supervision of the facilitators and district medical team. Participants in the process include health centre chiefs, ministry health personnel at all levels, community members, and development partners.

The author goes on to detail the steps in this process, which include:

1. Draw a map of each health zone including distances from the health centre to each village or community and population by community
2. Determine the population to be addressed by strategy (fixed, outreach, mobile)
3. Identify the main problems facing vaccination in the zone using available information (availability, access, drop-out, quality, other)
4. Identify corrective strategies and strategies to achieve objectives
5. Determine priority activities
6. Prepare a session plan - This step, which involves developing a systematic approach to fully immunising every infant and pregnant woman, "is the heart of good service delivery: plan sessions to reach the whole target population regularly, and build trust by keeping to the session plan." According to Ganivet, "the unreached" can be anywhere and can be unreached for many reasons. They include urban groups (issues include lack of awareness, fear of eviction, living in socially deprived areas), minorities such as certain religious communities, and those who are geographically remote, or nomads. The author reminds planners that "it is never possible to implement all planned activities, therefore decide on an order of priorities."
7. Determine monthly and annual needs for vaccines, syringes, safety boxes
8. Determine equipment needs (cold boxes, refrigerators, needle-removers, etc.)
9. Aggregate health zone plans into district and regional level plans: supervision, coordination, mobile strategy, supply.

The author concludes by detailing next steps at a district level, which include, first, developing a district workplan and, second, carrying out regular monitoring and review. The latter process might include monthly reports, quarterly review meetings, supportive supervisory visits, efforts to ensure data quality, and actions taken based on data analysis.

To request a copy of the full presentation, please see contact details, below.