Tools for Strengthening SIAs and Routine Immunization

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Tools for SIAs and RI Social
Mobilization
12th Annual Measles & Rubella Initiative Meeting
10th-11th September, 2013
WB Mbabazi, RJ Davis, M Charles, A Patel
1
Global Immunization Aspirations
1.
Global Measles goals

By 2015

Vaccination coverage:





Reported incidence:
Mortality reduction:
<5 cases of measles per million
95% (compared to 2000 Nos)
By 2020


2.
Routine: >90% national level and >80% in every district
SIAs: > 95% in M, MR or MMR in every district.
Sustain 2015 goals
> 95% coverage with both the first and second routine doses
of MCV (or measles- rubella-containing vaccine as
appropriate) in each district and nationally.
GVAP mission
Major Challenges for Measles Elimination
Have a communication Angle to the solutions
1)
Weak immunization systems
2)
Large outbreaks and changing
age distribution
3)
Funding
http://www.thelancet.com/journals/laninf/article/
PIIS1473-3099(13)70133-6/fulltext
BBC Caption (6th May 2013)
AMCROSS CONCEPTUAL
APPROACH AND TOOLS
For SIAs & RI promotion
5
Sustainable measles elimination
programming
Polio
Eradication
Measles control
MNT
Elimination
Meningitis
control
YF control
Influenza control
Adapted from IMMUNIZATIONbasics Project
House-to-House Strategy: Leveraging SIAs
experience into Routine Immunization

In SIAs, ARC has learnt that:




H2H canvassing reaches populations that are missed by
traditional mass media, even in urban areas.
Data from 13 African countries (Bob 2012) showed that higher
coverage are reached wherever H2H strategy was used
Cost per beneficiary averages $0.32 but can vary, being
about $0.16 in cities compared to $0.57 in rural areas
Testing H2H Strategy in immunization defaulters:


Prevention: Baby tracking in Kilindi district of Tanzania
Correction: Defaulters tracing in Dar es Salaam & 3
selected cities in Uganda
7
Using H2H strategy to look for 20M infants who
missed their MCV1
70% of them are from 10 Countries, using
2009-2011 JRF reported immunizations (in millions)
Top 10 Countries with DTP un & under-immunized
children in 2012, AFRO
Nigeria
2853024
Ethiopia
892012
Kenya
453129
Uganda
317994
DRC
286156
Zambia
229925
Tanzania
199826
Cameroun
142215
Madagascar
117857
Angola
86306
0
500000
1000000
1500000
2000000
2500000
Data Driven Selection of targeted countries and Districts
Where do the under- or un-immunized children live?
Arua
Lira
In Uganda
 80% of immunization
defaulters live in 36 districts
 URCS targeted 4 of 36
 Urbanized
 Highest numbers
 Testing the House-toHouse canvassing strategy
in defaulters tracing
 1st defaulters tracing week
took place in first week of
July, and was integrated
Greater
with the UNICEF supported
Kampala
(K’la & Wakiso)
“Family Health Days”.
Where do the under- or un-immunized children live?
In Tanzania
 80% of immunization defaulters
lived in 51 districts in 2009 and
70 districts in 2011
 National plan for correction of
missed immunizations as part
of RI coverage improvement
plan implemented since 2009
 Progressively more districts
attained 80% DTP-3 coverage
but the Greater Dar es Salaam
did not change
 TRCS supported to use the
House-to-House strategy in
turning fortunes in Dar
Improving DTP-3 trends but poor performance localized
2010
2009
2011
Below 80%
80% to 89%
90% +
Greater Dar
(3 Districts) remained
underperforming x 3yrs
Interventions description
Defaulters Tracing
 Campaign Approach
 Volunteers conduct
Quarterly H2H visits to
all H/Holds



Screening for RI
defaulters
Remind defaulters
Nudge defaulters to
correct missed doses
Baby Tracking
 Community-based
volunteers
 Identify and register all
newborn babies
 Conduct House-visits to
all families with infants


Remind them of the next
scheduled RI dose
Information on the next
planned EPI sessions
13
Delays in Project Start denies complete
outputs of H2H strategy in RI

In Uganda AMCROSS


Was drawn into the vaccine supply chain crisis for more than 6
months. Testing our advocacy and networking credentials
First H2H tracing for defaulters took place in July, 2013
Reached 50% of Households in selected 4 districts
 Found 79,316 children < 5yrs who have incomplete immunization
and supported 70% of them to update their immunizations


In Tanzania:

Translation of project proposals into implementation plans
delayed (Alignment with RED scale up plans, procuring buy in
from the 3-layers of government and development of M&E tools)

First H2H tracing of EPI defaulters planned for 15th to 21st Sep
14
Immunization program needs, priorities
SIA tools (Including Social Mob) can be used
to strengthen Routine Immunization
SIA input
RI Follow-up
Improved RI
micro-plans
implemented
Revised
population
estimates
Health worker
training
Cold chain
equipment
Fuel to
operate it for RI
Social mapping
immunization policy
makers and
defaulters
ooooops,
Reinforced
through
supervision, etc.
Defaulters tracing
H2H
Where&reminder
waseducative/
Social
system
Sustainable Elimination
Improved reach
of RI
Improved
quality of
services
RI improved
availability &
reliability
Sustained
Community
Mobilization?
Demand
Conclusions





There exists monitoring infrastructure to tell us where
unimmunized children are or live
MRI partners can advocate for routine MCV coverage
improvements, in selected high-priority countries
Each individual MRI partner can do small routine MCV
promotional interventions in the high-priority countries
contributing the most un and under-immunizations
Too early to tell, BUT H2H canvassing can find
defaulters and provide them reminders, incentives and
structures for correction of missed RI doses
Advocacy and social Mob stream of interventions
developed and used in SIAs that strengthen RI needed
16
Thank You
Anne Ray Charitable Trust
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