1
HEALTH SERVICES DELIVERY
1.4
DISEASE CONTROL PROGRAMME
1.4.2.d.1
Communicable Diseases Control: Immunisable Diseases Control:
Immunisable Diseases Control (as of March 2008)
A Focal Point
B Implementing Agencies
C Target Areas & Beneficiaries
Epidemiology Unit, Ministry of Health
Epidemiology Unit
Provincial Directors of Health Service
Regional Directors of Health Services
Infants, Children, adolescents, pregnant mothers and
ultimately to the benefit of the total population
Project Summary:
Provision of financially sustainable, safe and high quality immunization Programme while
sustaining the gains achieved and adhering to the eradication, elimination and control
strategies according to the national and international needs is the objective of the national
immunization Programme.
Introduction of new vaccines in to the Programme should be based on correct technical
evidence supplemented by disease burden and cost benefit studies.
The need for high quality, thorough surveillance supported by laboratory confirmation, is
heightened by the fact that EPI target disease incidence is very low in Sri Lanka. To maintain
the high coverage achieved and client confidence for immunization provision of very high
quality service is important with close monitoring and supervision at every level
The objective of the Project is to provide financially sustainable, safe and high quality
immunization service to the community while maintaining high coverage for the existing
antigens and achieving similar coverage for new antigens to achieve diseases
eradication, elimination and control objectives according to the national needs and
international commitments
1.
Justification:
It is well accepted that immunization is the most cost effective public health intervention ever
discovered by the medical community. Provision of immunization services in Sri Lanka is a
major success story. Virtually all-eligible infants, preschool children and pregnant women,
throughout the country, are receiving all their scheduled vaccines at the correct time. Impact
of it is very much visible by elimination of Poliomyelitis, Neonatal-Tetanus, Diphtheria and
remarkable reduction in adult tetanus, Measles and Whooping Cough. Impact of recently
introduced antigens such as Rubella, Hepatitis B and Hib vaccine is yet to be seen. However,
immunizations given during adolescence and adulthood (Rubella and adult Tetanus Diphtheria
vaccines) coverage need further improvements.
With the advent of more and more new vaccines and introduction of new antigens to the
immunization schedules of developed countries and also into the private sector locally, may
lead to pressure on EPI to introduce new costly antigens to the national schedule. Therefore
Epidemiology Unit should be well equipped to handle such situations based on evidence of
good surveillance, disease burden and cost benefit data.
2.
Important Assumptions/Risks/Conditions:
The Government of Sri Lanka will continue it’s policy of financing of
immunization programmes. The donor agencies (WHO, UNICEF, JICA, GAVI etc.) will
continue to provide technical and financial support for the immunization.
Increasing costs, both material and human resources and introduction of new vaccines may
increase the cost of immunization programme exponentially may lead to gaps in the
programme in the future, if the central government and provincial councils are not
ready to provide enough resources to the programme.
3.
Project Objective:
Objective
Provision of financially
sustainable, safe and high quality
immunization service to the
community while maintaining
high coverage for the existing
antigens and achieving similar
coverage for new antigens to
achieve diseases eradication,
elimination and control
strategies according to the
national needs and international
commitments
4.
Indicators
 Immunization coverage
 Target Disease
incidence
 Adverse events
following immunization
 Client satisfaction
 Provider satisfaction
Means of Verification
 Routine reports and
Periodical Surveys including
data quality Routine and
special disease surveillance
 Routine reporting and
periodical surveys
 Questionnaire survey
 Focal group discussions
Indicators
 Imminization coverage
for each antigen
Means of Verification
 Routine reports and
periodical surveys

Imminization coverage
for each antigen

Target disease
incidence

Project Output/Product:
Output
High coverage for existing
antigens maintained
High coverage achieved for
newly introduced antigens and
new antigens introduced in the
future
Disease reduction targets
achieved

Routine reports and
periodical surveys
Routine and special
disease surveillance data
 Laboratory surveillance
data
Safe immunization services
provided
Quality immunization services
provided
5.
Monitoring of adverse
events following
immunization
 % of service outlets
adhering to the minimum
standards

Routine reports and
periodical surveys

Routine supervisory
reports and periodical surveys

Related Projects:
Project No.
Project Title
Capacity Building Project
Development of Health Information System
Study Project on Job Description, Certification and Legislation of Primary
Health Care Workers
MCH Project
6.
Relevant Agencies to be Coordinated:
MOH, FHB, HEB, MRI, WHO, UNICEF, Ministry of Education
7.
Monitoring & Evaluation:
1. Who? Epidemiologist, MOH, Departments of Census and Statistics, Registrar
General, WHO, UNICEF
2. When? Quarterly Reports, Annual reports, Annual Surveys, Periodical Surveys
(DHS), Ad-hoc Surveys
3. What actions to be taken based on results of monitoring & evaluation?
Situational and periodical recommendations to the relevant authorities
Revision and/or establishment of acts/circulars/regulations/guidelines
Revision and/or establishment of training curriculum
Improved monitoring and supervision
8.
1
2
Activities:
Activities
Expected Results
Process Indicators
Continuous supply of good quality
vaccine, syringes and other logistics
Zero stock outs of
essential logistics at
all levels
% of districts with stock
out of essential logistics
during the year
Develop health education and social Good knowledge,
mobilization plan
positive attitude and
practice towards EPI
is maintained among
providers and clients
Availability of annual
IEC plan
% of planned activities
implemented
3
Strengthen the institutions in terms of
infrastructure and capacity
National, provincial,
regional & divisional
managers of the
programme
appropriately
equipped technically
& physically to
manage the
programme at their
respective levels
% availability of
technically qualified
mangers at each level
% of managers at each
level with adequate
office space
% of managers at each
level with adequate
communication facilities
% of managers at each
level with adequate
secretariat facilities
% of managers at each
level with adequate
office machines
4
5
Increase coordination of immunization
activities, among Epidemiology Unit,
FHB, HEB, MRI, Provincial EPI
offices and partner agencies
Motivation and team
work to be induced
Formation of
coordination teams &
having regular meetings
Improve EPI Data Management with
computerization of recording and
reporting
Complete, accurate
& timely data for
correct management
& decisions at all
levels
% completeness of
reporting at each level
% timeliness of reporting
at each level
% accuracy of reporting
at each level
6
Strengthen the surveillance of all
vaccine preventable diseases
Understanding the
impact of the EPI
Indicators are as for
activity no. 5
Trends of incidence of
EPI target diseases
7
Strengthen laboratory surveillance of
EPI target diseases
Understanding the
impact of the EPI
% of suspected cases
with laboratory
confirmation
8
Strengthen the management and
supervision at each level
Improved work
output
% of minimum
supervisory visits to each
staff category
9
Regular assessment of immunization
coverage by field surveys
Verification of
routine data with
survey data
No. of such surveys
conducted.
Regular updating of
knowledge, skills
and attitudes
% of health personal
trained as per annual
plan
10 Regular assessment of training needs,
develop training plans and ensure
implementation
(minimum 1 district
survey for year)
11 Renew and strengthen the cold chain
system
Uninterrupted
delivery & storage of
potent vaccine
No. of vaccine stock outs
& cold chain failures
reported
12 Upgrade the facilities for transport of
the vaccines and the field staff
Timely transport of
vaccines at all levels
& immunization
clinics conducted
without interruption
as scheduled
% availability of
adequate transport
facilities at all levels
13 Undertake reviews/assessments and
research studies
Understanding of the
pitfalls and unseen
problems of the
programme
% of such planned
studies/ reviews
conducted
14 Undertake disease burden studies of
vaccine preventable diseases/
sero-prevalence studies
Better understanding
of the other vaccine
preventable diseases.
Rational decision
making for
introduction of new
vaccines.
% of such planned
studies conducted