Using Measles SIAs to
Strengthen Routine
Immunization
Rebecca Fields, JSI
11th Annual Meeting
The Measles and Rubella Initiative
September 18, 2012
Extensive previous and recent work
on SIAs and health/immunization systems
“Disease
Taylor
Commission:
Effects of PEI
on health
systems
1994
1996
Jharkhand
study
(NPSP/
CDC)
Eradication:
Friend or Foe to
the Health
System”
1998
Checklist to
optimize
impact of
PEI on RI
2000
2002
2004
2006
UNF/
Red
Cross
Meeting
2008
Impact of measles
elimination on
health systems
(LSHTM)
2010
Nepal
SIAs –
WHO/
CDC
2012
Ethiopia:
Implementing
Best Practice
SIAs
Many SIAs in countries with MCV1 < 80%
and weaker health/immunization systems
MCV1 coverage, 2011
SIAs completed and planned,
2010-2013
Using Measles Activities to
Strengthen Immunization and
Surveillance: Objectives
1. Develop guidelines for countries on planning and
implementing SIAs in ways that deliberately
strengthen routine immunization and surveillance
2. Propose indicators to monitor and help manage
such efforts
3. Develop prototype advocacy materials to promote
measles control as a fundamental part of
immunization system strengthening
Field work to inform development of
guidance for countries
• Countries selected based on anticipated SIAs, routine
immunization coverage, geographic variation
– Lao PDR – August 2011
– Bihar State, India – December 2011
• Approximately 2 weeks of field work
– National level: interviews and data review
– Districts: visits to 4 districts/country; high/low RI performance;
urban/rural
– Facilities: >4 facilities to elicit health worker perspectives
• Field work supplemented with interviews and reviews
of experiences in Ethiopia, Jharkhand, Nepal, other
countries in Africa
Subset of large menu of possible activities
Program
area
Possible activities
When? Before/
During/After SIA
• Build planning for RI strengthening into all phases
of SIA planning (e.g. workshops, tools)
Before
• Use SIA head counts to revise target population for
RI microplans
After
• Use information on costs of reaching hard to reach
during SIAs to revise RI budgets
After
Training &
supervision
• Conduct needs assessment and include key topics
to reinforce routine immunization skills in SIA
training
Before
Monitoring
and
evaluation
• Use findings from SIA supervision checklists to
correct deficiencies for RI
After
• Apply findings from RCAs on source of information
to RI communication strategies
After
Planning
Possible activities (continued)
Program
Area
Communication/
social
mobilization/
advocacy
Possible Activities
When? Before/
During/After SIA
•
Provide key messages to caregivers on
need to return for RI and when (if
possible)
During
•
Foster strong relationship with media for
accurate, supportive coverage of RI
After
• Provide feedback to local community
and political leaders on SIAs and RI
During/
After
Vaccine supply
management
•
Post-SIA, physically inventory and
redistribute vaccine stocks
Cold chain/
Logistics
•
Update inventory, distribute new
equipment for SIA and RI needs
•
Use data on CCL problems identified
during SIA as basis to correct for RI
After
•
In SIA training, reinforce skills on
measles case detection and reporting
Before
Surveillance
After
Before
Process outlined in
country guidance module
1. Communicate and advocate for RI strengthening as an
integral component of a “Best Practice SIA.”
2. Assign clear responsibilities: before/during/after SIAs
3. Identify challenges to RI that SIAs can help address
4. Prioritize certain activities to strengthen RI and avert
negative impact  based on feasibility, potential
contribution, resources needed
5. Plan and budget for RI strengthening activities: include in
SIA guidelines
6. Monitor and evaluate to build accountability for this
component of SIA
Features of module for countries
•
•
•
•
•
Checklist to aid planning
Extensive menu of potential activities
“Scorecard” to help prioritize activities
Support for advocacy
Illustrative indicators and monitoring
approach
• Suggested format for post-SIA review
meeting on using SIA to strengthen routine
immunization and surveillance
Global-level indicators: characteristics
K. Feldon
• Limited to 1-2 to avoid imposing
burden
• Broadly applicable across
countries
• Easy to collect and report
• Meaningful; show connection
between SIAs and RI
• Avoid creating unrealistic
expectations about what SIAs will
do for RI
Indicators: Combine broad and specific
Broad: to gauge global
and regional progress AND
 Country plan, prepared and
funded using SIA resources, to
strengthen and monitor routine
immunization performance.
OR
 Structures to coordinate SIAs
and RI at national and
subnational levels are
established and functional
before, during, and after SIAs.
Specific: to describe
country priorities
 At least one indicator
describing a program area a
country selects for using SIAs
to strengthen RI
K. Feldon
What will it take to implement such activities?
A menu of ideas is not enough
 Political will on part of governments and partners:
RI strengthening needs to be deliberate part of highlevel advocacy and language for describing the SIA
 Budget: Limited but assured. Needed to secure
attention and commitment.
 Assignment of responsibilities: coordinating
structures at different levels responsible for the
SIA/RI interface: functional before and after the SIA
 Human resources
 Timeframe
Why use SIAs to strengthen
routine immunization?
 Routine immunization is essential to achieving high levels
of population immunity
 Prominent addition to the Global Measles Rubella
Strategic Plan
 Guiding Principles
 Milestones
 Performance indicators
 Adding this component incurs marginal costs but can lead
to specific, lasting improvements in RI, thereby helping
achieve elimination target
 SIAs may be viewed as more central to other efforts and
partners: NVI, developmental bilaterals, etc.
Thank you
E. Simons