Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Strengthening Routine Infant Immunization in EMR
Partners for Measles Advocacy
February, 2007
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Trends in DTP3 and MCV1 Coverage in the
EMR, 1994-2003
Percent coverage
100
80
DTP3/OPV3
60
Measles
40
20
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Year
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Reported Routine Immunization
Coverage, EMR0, 1994-2003
Percent coverage
100
80
DTP3/OPV3
Measles
HBV 3
60
40
20
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Year
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Reported Infants Routine Immunization Coverage
(2003)
10 0
90%
90
80
70
60
50
40
30
20
10
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
YEM
UAE
TUN
SYR
SUD
SOM
SAA
QAT
PAL
PAK
OMA
MOR
LIY
LEB
KWT
JOR
IRQ
IRA
EGY
DJI
BAH
AFG
0
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Distribution of Unvaccinated Infants in EMR, 2003
9%
9%
4.0%
Others
7%
AFG
YEM
IRQ
14%
SUD
SOM
7%
PAK
50%
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Key Constraints to Raising EPI Coverage
•
•
•
•
Insecurity (AFG, SOM, SUD, IRQ)
Poor management
Ongoing polio activities
Weak Health Systems
– Human resources
– Logistics
• Financial resources ????
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
REGIONAL PRIORITY 2003
Increase routine coverage in the 6 priority countries
Capacity development
•
•
•
RED approach
Vaccine management
Financial sustainability planning
Targeted technical assistance
•
•
RWG-GAVI
SSAs & STPs
Monitoring
–
–
District-level coverage
Frequent country visits
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Immunization Services Strengthening
05/2001
$7,255,000
Palestine
02/2001
$32,508,000
Bahrain
10/2001
$8,968,500
05/2001
$4,342,000
05/2002
$271,000
05/2002
$3,393,500
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Reported Routine Immunization
Coverage, EMR0, 1994-2005
Percent coverage
100
80
DTP3/OPV3
Measles
HBV 3
60
40
20
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
Year
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Reported DPT3 Routine Immunization Coverage in
Priority countries 2002-2005
2002
2003
2004
2005
10 0
90
80
70
60
50
40
30
20
10
0
AFG
DJI
IRQ
PAK
SOM
SUD
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
YEM
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Impact of RED on District
Performance (2002-2005)
100%
90%
% of districts
80%
70%
60%
50%
40%
30%
20%
10%
2005
YEM
2002
50<DPT3<79%
2005
SUD
2002
2005
PAK
2002
2005
IRQ
2002
2005
DPT3<50%
DJI
2002
AFG
2005
2002
2005
2002
0%
SOM
DPT3>=80%
Program Management Reform Sudan (2001 – 2005)
1.
Governance tools designed & strengthened;
1.
2.
3.
2.
Resource development;
1.
2.
3.
3.
Strategic planning addressing all program components/ DC
Effective coordination
Knowledge & Information (strong database and M&E system)
Capacity building (TOT training 100%, Refresher 70%, SOPs)
Rehabilitation of the infrastructure (Cold chain,
communication & Transport > 2 million $)
Mobilization of local resources (using GAVI money)
Service delivery;
1.
2.
3.
Addressing Access & Utilization issues (RED approach)
Quality Immunization & safety issues
Integration? (District Health System)
Components of RED in Sudan
1. Re-establishment of outreach vaccination…
2. Supportive supervision…
3. Link between community and service…
4. Monitoring for action…
5. Planning and management of resources…
Re-establishing Outreach
Vaccination Services in Sudan
7000
6000
5000
828
4048
3925
205
4000
3000
240
2000
2059
1000
0
410
3121
865
1079
1153
1148
2002
2003
2004
2005
Fixed sites
Outreaches
Mobile units
Sustaining Outreach services…
– Deliver immunization services on basis
of periodic contact to people with limited
or no access
– Community participation is vital…
– Campaign and/or outreach depending on
operational constraints like distance,
population density and terrain.
Supportive supervision…
•
•
•
•
•
Planned, joint activity…
On- site training…
Use DQS as a tool (2005)…
Performance was carefully
measured using quality
indicators…
Good performance was
acknowledged and rewarded…
Link with community…
•
Advocacy meetings to revitalize the political
commitment/ ICC…
•
Establishing EPI friends Associations in some
states (NIDs’ volunteers)…
•
Use existing community structure to trace &
retrieve the defaulters…
•
Use of polio campaigns to advocate for routine
immunization/ IEC…
•
Feedback to community (still Ad Hoc)…
Monitoring for action…Sudan
•
Use maps, graphs and
charts to;
–
Map vaccination coverage
and drop-out rates by
health facility & each
district…
–
Follow trend of
performance of each
health facility & each
district.
–
Send regular feedback &
feed forward…
Monitoring for action…2
•
Conduct regular
(monthly “State”
and quarterly
“Federal”) review
meetings:
–
Opportunity for onsite training…
–
Problem solving…
–
Feedback…
Planning and management of resources…1

Set up teams (Federal/
State/ Locality):
1. Technical support and
need assessment…
2.
Familiarization of
participants on the RED
approach and its
implementation…

District planning
workshops; the 5 steps
were followed to develop
the districts micro-plans…

Rational use of polio
infrastructure/
experience…
The 5 steps:
Prioritization for implementation
Operational considerations for
implementation of RED approach:
•
Effective and
efficient logistics
management
which includes;
–
–
–
Vaccine
management
Cold chain
management
Maintenance
management for all
equipments
Group (1): Good performing States,
Achievements 2002 - 2005
Gezira
River Nile
96
100
90
80
70
60
50
40
30
20
10
0
02
20
94
03
20
98
04
20
95
100
90
80
70
60
50
40
30
20
10
0
05
20
86
100
02
20
98
03
20
100
04
20
86
85
81
02
20
Gedarif
100
90
80
70
60
50
40
30
20
10
0
Blue Nile
03
20
04
20
100
90
80
70
60
50
40
30
20
10
0
02
20
05
20
05
20
100
90
80
70
60
50
40
30
20
10
0
97
85.7
02
20
80
03
20
04
20
03
20
89
04
20
100
05
20
White Nile
S. Kordofan
97
92
88
86
05
20
100
90
80
70
60
50
40
30
20
10
0
91
02
20
89
03
20
85
04
20
89
05
20
Group (2): Medium Performing States,
Achievements 2002 – 2005…1
N. Kordofan
Sennar
100
90
80
70
60
50
40
30
20
10
0
94
85
92
95
100
93
99
90
80
70
54.4
65
60
50
40
30
20
10
0
02
20
03
20
04
20
02
20
05
20
03
20
Kassala
100
90
80
70
60
50
40
30
20
10
0
Red Sea
82
03
20
05
20
84
88
84
04
20
05
20
100
90
80
70
60
50
40
30
20
10
0
82
88
64.6
02
20
03
20
04
20
03
20
04
20
05
20
Northern
84
41
02
20
84
75
W. Kordofan
41
02
20
04
20
100
90
80
70
60
50
40
30
20
10
0
05
20
100
90
80
70
60
50
40
30
20
10
0
73
76
81
68.1
02
20
03
20
04
20
05
20
Group (2): Medium Performing States,
Achievements 2002 – 2005…2
Khartoum
100
90
80
70
60
50
40
30
20
10
0
76
02
20
100
90
80
70
60
50
40
30
20
10
0
77
03
20
81
04
20
S. Darfur
88
05
20
W. Darfur
63
65
55.4
44.5
2
00
3
00
4
00
100
90
80
70
60
50
40
30
20
10
0
5
00
86
70
50
02
20
100
90
80
70
60
50
40
30
20
10
0
76
03
20
04
20
05
20
N. Darfur
61
45.4
51
36.3
2
00
3
00
4
00
5
00
Group (3): low performing States,
Achievements 2002 - 2005
Bahr Algabal
Unity
100
90
80
70
60
50
40
30
20
10
0
100
80
50
31
02
20
03
20
04
20
100
90
80
70
60
50
40
30
20
10
0
05
20
89
79
45.5
02
20
W. B. Gazal
100
90
80
70
60
50
40
30
20
10
0
68
67
34
03
20
04
20
03
20
04
20
05
20
E. Equatoria
44
02
20
48
05
20
100
90
80
70
60
50
40
30
20
10
0
54
25
2
02
20
3
03
20
04
20
05
20
100
90
80
70
60
50
40
30
20
10
0
100
90
80
70
60
50
40
30
20
10
0
100
90
80
70
60
50
40
30
20
10
0
Upper Nile
57
72
61
Upper Nile
34
02
20
03
20
Jongli Jongli
04
20
21
9
02
20
05
20
27
9
03
20
04
20
05
20
N. B. Gazal
8
11
14
0
02
20
03
20
04
20
05
20
EPI Performance Sudan, 2002- 2005
DTP3 in 2003
DTP3 in 2002
100
80
60
40
20
DTP3 in 2005
OPV3
> 80%
DPT3
BCG
2005
2004
2003
0
2002
DTP3 in 2004
Measles
50 – 79%
< 50%
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Summary
Strengthening Routine EPI in the EMR
• Impact of GAVI input:
– SUD, YEM & AFG ++++
– PAK & DJI ++
– SOM & sSUD: ??
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
Summary
Strengthening Routine EPI in the EMR
• Lessons learned
– PAK:
• Channeling financial resources to operational level
• Devolution
• Rigidity in financial rules
– DJI: Human resources issue
– SOM & sSUD:
• Insecurity
• Poor coordination between partners
– ALL:
• Health system barriers not/poorly addressed
• End of 5 years ISS support +++
Measles Partnership Meeting, Washington, DC, USA, 27-28 February 2007
Eastern Mediterranean Regional Office
Vaccines Preventable Diseases & Immunization
GIM Meeting, New York, USA, 13-15 February 2007