Issue 3, December 2012 **Special Partners’ Forum Edition**

The Civil Society Dose

A quarterly newsletter of the GAVI CSO Constituency

Civil Society on the RISE- CSO Case Studies on Results, Innovation, Sustainability and Equity in Immunisation

Copyright: Stuart Ramson/UN Foundation

Table of Contents

From the Editors p. 3 Results p. 3

Innovation p. 7 Sustainability p. 10 Equity p.13

Reaching every child with immunisation Table of Contents

Note from the Editors

RISE Case Studies

Results- Page 3 1. Strengthening Participation of Health NGOs Network Members in the Kenyan Health Sector (Immunisation and Vaccination)—p2 2. How Comprehensive Primary Health Care Programs Can Strengthen Routine Vaccination Services—p3 3. HPV Vaccination in Honduras Succeeds Despite Limited Resources and Insecurity—p4 4. The Model Volunteer Vaccinator of Skardu—p5

Innovation- Page 6 1. USAID/MCHIP Contribute in Effort to Tighten the ―Meningitis Belt‖: MenAfriVac Campaign in —p6 2. Bolivian NGO Works with the Government to Vaccinate the Country’s Most Vulnerable Young Girls against Cervical Cancer—p7 3. Illuminating the Last Mile—p8 4. Building a Virtual Community—p8

Sustainability- Page 9 1. Editorial: Pakistan’s Internal Investments and Community Ownership are Crucial To Combating Polio and Other Vaccine-Preventable Diseases—p9 2. SIVAC Supports the Mozambican Committee of Experts on Immunisation (CoPI)—p10 3. RAPID as a Quality Improvement Model for Routine Immunisation Services Through Partnership with Government: Experience from India—p11

Equity- Page 12 1. Baptism of Fire: New CSO Group Reaching Hard-to-Reach Religious Sect with Immunisation Services in —p12 2. Kahindo Motogari, Pygmy Woman in the DRC, Involved in Vaccine Sensitization—p13 3. Vaccinating Disadvantaged Children in one of Nairobi’s Biggest Slums—p13 4. Immunisation For All: Empowering Communities To Ensure No Child is Left Behind—p15 5. The REAL Awards: Honoring Health Workers like Rekha Bangarwa—p15

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Note from the Editors: Welcome to !

Welcome to this Special Partners’ Forum A big thank you to all of the organisations Edition of The Dose! In keeping with the and authors who submitted articles and theme of the Partners’ Forum-- results, contributed resources to make possible innovation, sustainability and equity this special issue of The Dose. We are (RISE)-- we’re excited to bring together honored to share your stories of success 16 articles and case studies focusing on and hope that our colleagues around the

the role of civil society in achieving world will learn from them. We are also results, driving innovation, increasing grateful for the generosity and support of sustainability and operationalizing equity PATH, who made possible the printing of in immunisation. From Senegal to this special edition. The Dose is an Kenya, India to Honduras, and Pakistan entirely volunteer effort, an un-branded to , civil society is a trusted cooperation among dozens of and innovative partner bringing the organisations ranging from the benefits of immunisation to all. community to the global level.

We would like to draw your attention to Without further ado, we invite you to articles labeled ―GAVI CSO SG2 enjoy this special issue, packed full of

platform” as these are a first look at how news from the front lines of GAVI-supported country-level CSO immunisation. platforms are working to increase civil society participation in addressing Welcome to Tanzania! immunisation and health system constraints. Happy reading, Your editorial team

RISE Case Studies: Results Inside Story Headline

R1: Strengthening Participation of Health

NGOs Network Members in the Kenyan Health

Sector (Immunisation and Vaccination)

GAVI CSO SG2 platform—Kenya

Introduction The Health NGOs Network (HENNET) who have diverse interests, but share a Ruth Wanja was founded in 2005 to fill a long- common vision of a ―Healthy Kenyan Project Officer, HENNET standing gap in civil society coordination Society‖. and networking in the health sector. Zaddock Okeno HENNET Coordinator, HENNET is a forum where Civil Society HENNET is currently implementing a HENNET Organisations (CSOs) implementing GAVI funded project to support civil various health interventions can society participation in the health system collaborate, share experience and funding platform (HSFP). advocate with a united voice. It brings Continued… together different health-oriented CSOs

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The project’s goal is to contribute to working towards partnering with the strengthening the capacity of integrated Ministry of Health to improve access to health systems to deliver immunisation and create demand for immunisation by resolving health system constraints, services among the marginalized and increasing the level of equity in access to underserved populations in Kenya. They services, and strengthening civil society have also actively participated in different engagement in the health sector. As a MoH fora, increasing their understanding start up activity, HENNET held a of the Kenyan health sector. stakeholders meeting with 21 civil society organisations to introduce the GAVI-CSO Looking toward the future HSFP Project to its members. During the Through a situational analysis currently meeting, an 11-member technical underway, HENNET will identify existing working group was elected, representing gaps within its membership and build five project thematic areas: health system relevant capacities to realize better strengthening, advocacy, capacity engagement in the areas of immunisation building, child health, and resource and vaccination. The study will also yield mobilization. The group is mandated by evidence-based results on the strengths the HENNET constituency to represent of its platform members. Members will other network members during project gain skills and knowledge on HSS, implementation. HSFP, advocacy and policy planning

through training facilitated by HENNET Impact of the GAVI CSO project and supported by GAVI. This will enable Through the GAVI CSO project, working them to become agents of change, group members have improved their influencing communities at the grassroots understanding of the immunisation and level and thereby increasing access to vaccination situation in Kenya. They have immunisation services and resolving also gained knowledge on GAVI priorities health system constraints. for CSOs. The network members are

R2: How Comprehensive Primary Health Care Programs Can Strengthen Routine Vaccination Services Younoussa Diallo Health Coordinator, DR Since 2009, DfID, the IRC, and the facilities and institutional support Congo, International Rescue Committee Ministry of Public Health have provided including immunisation. In supported

broad health systems support to Ubundu facilities, Expanded Program on

health zone, Province Orientale, in North- Immunisation (EPI) staff is present, the East Democratic Republic of Congo. The cold chain is maintained, and community main objective of the program is the health workers actively promote availability of reliable and free care to immunisation. Caregivers are also more children under five and pregnant women. likely to have their children immunized Support included the provision of because they have a renewed sense of equipment and medical supplies, support trust and confidence in health center for in-service training, incentive payments staff. Alice Gilbert for health center and health zone staff, Continued… Deputy Health Director, DR provision of running costs for health Congo, International Rescue Committee

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In August 2011, a measles epidemic focus on prevention and routine services, broke out in Lowa health zone, adjoining rather than crisis management. Ubundu health zone, and spread into Ubundu; however, the epidemic had very Interestingly, more measles cases (978) different courses in each zone. In Lowa, were reported in Ubundu than in Lowa where routine data indicated measles (634), despite Ubundu’s higher coverage. Lara Ho coverage was 47%, there were 18 deaths An investigation by the Ministry of Public Technical Advisor, Health Technical Unit, International by December 2011, compared to only Health indicated that the higher figures in

Rescue Committee nine in Ubundu, where measles coverage Ubundu were the result of cases

was 91%. Local health authorities were originating from Lowa, but traveling to

compelled to initiate a mass vaccination Ubundu for free care, greater availability

campaign in Lowa due to low coverage of vaccines and drugs, and higher quality

and high mortality. In contrast, health of services. Despite this movement, the authorities in Ubundu were able to rely epidemic did not spread further because

on the strong routine coverage, which of the high vaccination coverage in saved money, and allowed health staff to Ubundu.

R3: HPV Vaccination in Honduras Succeeds Despite Limited Resources and Insecurity

In Honduras, cervical cancer remains a Meredith Paddock leading cause of death among women, Global Health Program creating a desperate need for prevention Manager, Catholic Medical Mission Board and early diagnosis. The child immunisation rate of more than 98% Marylena Arita-Fu provides an excellent vaccination platform Country Representative, Honduras, Catholic Medical for Honduras to address human papilloma Mission Board virus (HPV) and cervical cancer prevention. With a donation from the Erin Snyder-Ulric Regional Manager, Latin Gardasil Access Program, Catholic America & The Caribbean, Medical Mission Board (CMMB) is Catholic Medical Mission partnering with the Ministry of Health and Board local healthcare organisations to vaccinate 28,800 girls aged 10 and 11.

CMMB and its partners launched the first doses in Olancho and Cortes department Several lessons learned from the small- scale project will help inform future GAVI schools during March 2012. To date, more and CSO efforts to provide HPV than 40,000 doses have been vaccination programs. A critical administered, despite numerous component of HPV vaccination is challenges including insecurity and gang educating girls and caretakers about the violence, vehicle unavailability and remote vaccine’s benefits and the importance of area access, and the labor disputes of committing to multiple dosing. CMMB teachers, nurses and school sought strong partnerships, active participation of school personnel, and the administrators. Teams of healthcare media to enhance awareness to improve workers and program coordinators will the census and consent processes. administer an additional 46,000 doses by the end of 2013. Continued…

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Census data and vaccine registries could has led to vehicle and staff shortages have been improved with more accurate and even more effort focused on follow- school data and community meetings with up. To maximize follow-up and complete caretakers. However, the HPV vaccination the girls’ doses, teams will introduce acceptance was high, with a 95 percent short messaging service (SMS) to notify acceptance rate among caretakers, school caretakers and teachers of upcoming administrators, and community members. vaccinations.

HPV vaccines create additional complexity The project has sparked interest in given their three -dose regimen and the developing guidelines and infrastructure difficulties of completing this regimen on for a national HPV vaccination program schedule within a school year of nine in Honduras, but the cost remains high. months. Slower vaccination rates and Currently, the program administration differences between the private and public costs average $0.53 per dose (with school calendar made it difficult to donated vaccine). For the project, vaccinate girls at their schools, resulting in partnerships were established with local vaccination teams completing dosage via NGOs, Ministries, and pharmaceutical home-based visits for clients who missed donors to maximize expenses and their second or third dose at school. This shared resources.

R4: The Model Volunteer Vaccinator of Skardu GAVI CSO SG2 platform—Pakistan

Located on a towering, barren mountain the twenty-year-old health promoter of off the Karakoram highway, over 60 km Khar Bashu, Syed Mustafa. Lubna Hashmat Chief Executive Officer, Civil away from Skardu city in Gilgit Baltistan Society Human and province of Pakistan, a treacherous ―Over the past three years, at least in my Institutional Development ascent over a narrow stone path that knowledge, there have been no deaths in Programme (CHIP), Pakistan remains buried under deep snow during this area.‖ the long winter months leads into the village of Khar Bashu. Khar Bashu has become home to two active health promoters, a volunteer ―Until 2009 at least two maternal and vaccinator, and gender-segregated infant deaths would take place each year Village Health Committees responsible in Khar Bashu. If we add up fatalities for mobilizing communities around the from the three other villages on this importance of immunisation and child mountain, it was ten to fifteen1,‖ shares health.

1 Neighboring villages include Nazimabad, Continued… Sultanabad and Matillo Bashu

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―When I began working in 2009, women perseveration and administration of were afraid of vaccines - they did not vaccines. know what was in them and why they were necessary for themselves, or their ―Not more than 70 percent of children children. They would simply refuse to were vaccinated in Khar Bashu before I listen when I would try to clarify their began my work. Even out of these, most doubts during door-to-door information either received the dosage late or missed sessions,‖ explains the 22 year-old certain doses altogether. But today, each volunteer vaccinator of Khar Bashu, child and mother in Khar Bashu is Muhammad Reza. immunized on time.‖

Reza did not allow the initially negative Achieving full coverage was no mean response of the community deter his feat. ―I accompany the government ambition of contributing to enhanced EPI vaccinator during his quarterly visits to coverage in the area. He has been the village to make sure he visits each empowered by Civil Society Human and home and maintains a separate record of Institutional Development Programme women and children who require (CHIP) during numerous trainings, immunisation. I also distribute EPI cards including a week long exposure visit to to families between visits.‖ To maintain the Skardu District Head Quarter Hospital the impacts of his work, Reza envisions where he learned about the composition, the creation of a network of volunteer vaccinators.

RISE Case Studies: Innovation

I1: USAID/MCHIP Contribute in Effort to Tighten the “Meningitis Belt”: MenAfriVac Campaign in Senegal

Meningitis is not a popular topic on the Organisation (WHO) and PATH, has pre- global health scene, but for those living in tested this new vaccine in Burkina Faso, the ―meningitis belt‖ that runs from Mali and Niger with compelling results. Senegal to Ethiopia, it remains a major Lindsay Bever public health concern. An inflammation of This month, The U.S. Agency for Program Coordinator, MCHIP, John Snow, INC the meninges, meningitis can lead to International Development (USAID)’s death or long-term consequences such flagship Maternal and Child Health as deafness, epilepsy and mental Integrated Program (MCHIP) will retardation if left untreated. collaborate with the MVP to implement a MenAfriVac campaign in Senegal, Initially, the only vaccine available was targeting all children and adults from 1-29 weak, used primarily in areas with active years old. The Senegalese Ministry of meningitis outbreaks. These reactive Health, in collaboration with MCHIP, campaigns were expensive and MVP, UNICEF, WHO and other partners, ineffective. In contrast with the previous will target about 3.9 million people in licensed polysaccharide vaccine, the new eight of the highest-risk regions. This Men A conjugate vaccine (MenAfriVac) includes mobile populations and those induces a long lasting superior immunity, aged 15-29 years, both notoriously results in herd immunity, and can protect difficult populations to reach. Health children younger than two years old, facilities at fixed sites, outreach, and Michel Othepa providing protection for up to 10 years. mobile strategies will be used, focusing Senior Immunisation Technical Advisor, MCHIP, The Meningitis Vaccine Project (MVP), a on those most in need. John Snow, INC partnership between the World Health Continued…

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MCHIP played an active role during to assess the campaign’s quality. campaign preparation, providing technical support during the planning This campaign in Senegal, along with process at regional and district levels, others in the ―meningitis belt,‖ has the developing an activity monitoring potential to significantly reduce the checklist, and finalizing the guidelines number of meningitis cases and and management tools. The Program will associated deaths in the region. After the also work with partners to supervise and campaign in November, this ―meningitis provide guidance during the campaign, belt‖ may lose a few notches. and to monitor and evaluate afterwards I2: Bolivian NGO Works with the Government to Vaccinate the Country’s Most Vulnerable Young Girls Against Cervical Cancer

The most prevalent and lethal cancer in the vaccine and cervical cancer Bolivia, cervical cancer, creates serious prevention. Impressively, CIES achieved public health and economic burdens for over a 90% 3rd dose completion—far an already struggling country. Over 1,400 exceeding the US average of 54%. Even women in the country are diagnosed with more impressive was that this was Alejandra Meglioli cervical cancer each year, and five achieved among the most poor and Senior Program Officer, women die daily from this preventable under-served populations in Bolivia. In International Planned disease1. The tragedy extends beyond nearly all municipalities where the project Parenthood their early deaths, creating devastating has been implemented, the number of Federation/Western Hemisphere Region effects in the family. girls vaccinated grew dramatically from (IPPF/WHR) the first year to the second, proving In 2009, CIES (Centro de Investigación, increased vaccine acceptability, demand Educación y Servicios), began an generation, and coverage. Unlike many innovative cervical cancer vaccination vaccination campaigns, CIES’ was project, bringing the HPV vaccine to girls conducted horizontally, incorporating a in extremely impoverished municipalities multi-sectorial approach, partnering with with very difficult access to health government and educational institutions. services and a high rate of incidence and Given CIES’ proven track record and mortality from cervical cancer. CIES strong relationships with the government focused on indigenous communities, in the implementation of this project, it is which often have little knowledge about well-positioned to support the cervical cancer. At the campaign’s government achieve HPV vaccine inception, the HPV vaccine was new and universal coverage. controversial, facing fervent resistance Jenny Shapiro from feminist and religious groups. CIES Through this project, CIES has left a Resource Mobilization Officer, International bravely undertook this taboo project to lasting impact on Bolivia and the Latin Planned Parenthood save the lives of women and girls. Girls American region—demonstrating that Federation/Western were vaccinated both in their schools, their HPV vaccine delivery model is Hemisphere Region which facilitated follow-up, and through feasible, socially acceptable, and (IPPF/WHR) mobile health units. Between 2009 and technically viable in both urban and rural 2011, CIES vaccinated 75,946 girls. settings, and among indigenous populations. CIES has provided the The project focused beyond just government with lessons learned and vaccinating girls, also involving and tools that can easily be used when it is educating teachers, boys, parents and ready to include the vaccine as part of medical providers on the importance of the national immunisation program.

1 International Agency for Research on Cancer, 2008. Reaching every child with immunisation The Civil Society Dose Page 8 of 17

I3: Illuminating the Last Mile

Until a vaccine is administered, it is just logistics management information system to manage the vaccine distribution to clear liquid in a small glass container; its almost half Mozambique’s immunisation real value has yet to be realized. To posts, most of which are in the country’s change from clear liquid to a modern most-difficult-to-access regions, well miracle of global health, vaccines must travel through the final segment of the beyond the reach of the electrical grid supply chain or ―last mile.‖ In most GAVI- and, in many cases, beyond the reach of cellular networks. In these areas, the eligible countries, that last mile covers Timóteo Chaluco MoH has established and operates the most challenging terrain to thousands Monitoring and Evaluation regular monthly distribution of vaccines to of immunisation posts where poor Officer, VillageReach each immunisation post. With regular Mozambique physical infrastructure, limited financial resources and lack of human resources deliveries, we recognized the MoH could present severe challenges to managing use this same network of trucks carrying vaccines to immunisation posts as a vaccine distribution and associated cold network to collect data on last mile chain. Those same challenges supply chain performance. It could also compound the last mile supply chain serve as a network to distribute useful management problem by making it very difficult to implement and maintain a information to key stakeholders. In effect, logistics management information system the last mile of delivery is the first mile of information. that can illuminate supply chain

performance for those operating and Each month, the information system managing the system. It is hard to manage what you can’t measure or even collects data from immunisation posts see. regarding vaccines delivered, stock on hand, stock-outs, cold chain

performance, wastage rates, doses Working with the Mozambique Ministry of administered and other key metrics. Health (MoH) at the provincial, district Managers now have a clear view of what and immunisation post level, VillageReach developed an online needs to be done to change clear liquid into modern miracles.

I4: Building a Virtual Community To Conquer a Resilient Threat

When PATH set out to raise awareness picture, resources were disparate. In about rotavirus vaccines in the countries 2009, PATH connected the dots with the where they were most needed, we launch of www.defeatDD.org. While our Deborah Phillips quickly learned two important lessons. primary aim remained raising awareness Communications Officer, First, while ministry officials were about rotavirus vaccines, we saw an PATH rightfully concerned about rotavirus, the opportunity to command greater attention overarching threat of diarrheal disease and increase demand by positioning caused greater alarm. Second, they had vaccines as part of an integrated no place to turn to find resources, tools, approach to diarrheal disease: one that and success stories with which to state highlighted all available interventions, like the case for national funding of rotavirus breastfeeding, zinc, oral rehydration, and vaccines and other essential tools to clean water, alongside vaccines. control diarrhea. Social media profiles on Facebook and Several NGOs talked about vaccines, Twitter followed, prompting conversations others about nutrition, still others about with grass-roots groups fighting diarrhea safe water. Sometimes they talked to in vulnerable countries. Hope Randall Communications each other, often not. For a diarrheal Associate, PATH diseases advocate looking at the big Continued…

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We share their successes with other education of families about nutrition, safe country-level NGOs and decision-makers water, and breastfeeding. Then we eager for proven, affordable, and learned even more. We learned about accessible approa ches. Water and Sanitation for the Urban Poor and their work keeping peri-urban Consider . Through conversations settlements healthy. We learned about launched both in person and online, we Africare’s program to teach students learned about a rotavirus vaccine rollout hygiene lessons that made them undertaken by the Ministry of Health, the teachers in their own right, as they Centre for Infectious Disease Research, brought lifesaving messages to their Zambia, and Absolute Return for Kids. communities. These are the stories Then we learned this rollout was in the defeatDD was made to tell! And we feel context of comprehensive diarrhea so fortunate to have an opportunity and a prevention and treatment, with oral platform from which to share such rehydration corners installed in clinics, important work. zinc provided in routine care, and

RISE Case Studies: Sustainability

S1: Editorial: Pakistan’s Internal Investments and

Community Ownership are Crucial To Combating Polio and Other Vaccine-Preventable Diseases

A year ago, Pakistan was in the news with The President and Prime Minister have a significant increase in polio cases – 136 spearheaded the development and cases documented across a number of implementation of a new National affected districts and provinces. Several Emergency Action Plan that ensures reasons were cited for this program failure accountability in improving the quality of Zulfiqar Bhutta including population displacement due to vaccination campaigns as well as Head, Division of Maternal and Child floods and conflict in the North, poor innovative strategies to increase Health, Aga Khan program management and political community engagement and ownership, University Medical support. This year has seen a remarkable especially among Pashtun populations. Center reversal with only 48 cases reported to- date in half of the districts affected in Community ownership is crucial to the 2011. Baluchistan, one of the epicenters successful implementation and of polio in 2011, has had only four cases sustainability of many public health reported from two districts this year, interventions, and the polio program is no compared to 64 cases in 11 districts in exception. The engagement of local 2011. These gains are all the more community leaders, especially religious remarkable considering the steady stream scholars, has been critical in reaching at- of challenges over the last year related to risk populations. Additionally, the security issues and the devolution of the involvement of well-trained and federal health ministry to the provinces. disciplined Pashtun vaccinators has helped decrease vaccine refusal rates. Political support and stewardship at the Efforts are underway to engage national highest level have been critical. Much of and local champions for community Pakistan’s progress against polio this year mobilization and to involve the large has stemmed from the government’s private sector in the final stages of polio internal investments and efforts to engage eradication. local communities. Continued…

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Notwithstanding the above, there are immunizing children should engage persistent challenges as well as community leaders and youth. opportunities. Efforts to integrate routine Organisations such as the Trust for immunisation services with the polio Vaccines and Immunisations (TVI), program have been less than optimal, as Health & Nutrition Development Society are the persistent gaps between the (HANDS), Health and Literacy Promotion ―immunisation system‖ and maternal and (HELP) etc. may play a major role child health programs. A huge therein. Perhaps polio eradication can opportunity for immunisation advocacy open the door to accelerating national has arisen as Pakistan became the first ownership and investments in Pakistan’s country in South Asia to introduce health issues more broadly, including pneumococcal vaccine. A strong civil maternal and child health and nutrition. society movement committed to S2: SIVAC Supports the Mozambican Committee of Experts on Immunisation (CoPI) To Develop Recommendations for Appropriate and Sustainable Evidence-Based Decisions

In January 2011, the Mozambican elimination and rubella control, logistics Minister of Health issued a decree to and cold chain, pharmacovigilance, and form a National Immunisation Advisory more. These recommendations reflect Group (NITAG) called the ―Comité de the specificities of the Mozambican Antoine Durupt SIVAC Program Peritos de Imunização‖ (Committee of context. As such, they empower the Operations Manager, Experts on Immunisation, CoPI). government to make appropriate and Agence de Médecine Designed by a national team under the sustainable decisions that will have a Préventive mandate of the Minister of Health, the significant long-term impact on CoPI is a multi-disciplinary group of population health. national experts in medicine, public health, and immunisation. The SIVAC Initiative provided technical Representatives from health partners and financial support for the creation of (WHO, UNICEF, professional the CoPI, and continues to support its associations, NGOs, etc.) are also invited functioning. Funded by the Bill & Melinda to participate in meetings. Gates Foundation, SIVAC is a program led by the Agence de Médecine A NITAG is a body of national experts Préventive (AMP) in close collaboration that advises the Ministry of Health on all with WHO and other partners. SIVAC Alex Adjagba SIVAC Deputy Director, topics related to vaccines and aims to support low- and middle-income Agence de Médecine immunisation, such as the introduction of countries in improving their capacity to Préventive new vaccines, appropriate vaccine make immunisation and vaccine schedules, financing, and research decisions based on evidence through a priorities and strategies. In the context of wide range of activities and especially the increasing complexity of immunisation creation and strengthening of NITAGs. and vaccine decisions, ensuring relevance of decisions by identifying and In line with recommendations from the using national expertise, through Decade of Vaccines (DoV) and the World NITAGs, has proven critical.1 Health Assembly (WHA)1, SIVAC intends to continue supporting the establishment The CoPI holds biannual technical of NITAGs in other countries in the meetings during which it reviews national coming years to enhance national Kamel Senouci evidence on various topics. To date, it ownership of decisions related to SIVAC Director, Agence has issued several recommendations to immunisation and vaccines. de Médecine Préventive the Minister of Health on measles Reaching every child with immunisation The Civil Society Dose Page 11 of 17

S3: RAPID as a Quality Improvement Model for Routine Immunisation Services Through

Partnership with Government: Experience from India

Supportive supervision is a key component for Karan Singh Sagar successful implementation Country Representative, and monitoring of any MCHIP India public health intervention. The Regular Appraisal of Program Implementation in a District (RAPID) is a model for assessment and supervision developed by the USAID- Five RAPID rounds were conducted in funded Maternal and Child Health two focus districts of Jharkhand State (12 Integrated Program (MCHIP), which aims cold chain points) and three rounds in to improve quality of immunisation five districts of Uttar Pradesh (39 cold services and has demonstrated success chain points), over a period of 22 months in several districts in India. (February 2010-September 2012). In

Jharkhand, facilities graduated from 36% The RAPID approach entails a three-day poor, 55% average and only 9% good assessment of immunisation services at (during round 1) to 75% good and 25% all sub-district cold chain points through average (after fifth round). In Uttar trained supervisors guided by a checklist Pradesh, during first round, 81% facilities Gunjan Taneja covering 46 parameters. Onsite Immunisation Technical were poor and 19% were average, which corrections, capacity building and data Officer, Jharkhand, MCHIP improved to 18% good, 79% average and India collection are parts of the assessment. In only 3% poor after 3 rounds of RAPID. addition, training and engagement of facility staff help to make the RAPID After seeing the results the government approach sustainable. Data are entered of Jharkhand and Haryana decided to into an Excel-based tool to generate conduct RAPID in all districts throughout scores and graphs. Each facility is the state and In Uttar Pradesh, UNICEF categorized as good, average or poor decided to implement the approach in 32 based on the performance. Biannual of the 75 districts. RAPID rounds are conducted in focus districts (through a partnership with As a result of the RAPID approach, government, MCHIP and partners) to quality improvement of immunisation enable tracking of progress and continual service delivery has been facilitated monitoring and improvement. through joint situational analysis and problem solving with the health staff. Manish Jain The RAPID approach empowers health State Representative, UP, MCHIP India staff in a participatory way to handle issues and influence behaviour change. Thus this approach is sustainable, builds

capacity and can be adapted at scale.

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RISE Case Studies: Equity E1 : Baptism of Fire: New CSO Group Reaching Hard -to-Reach Religious Group with

Immunisation Services in Malawi

GAVI CSO SG2 platform—Malawi

17 year old Mary John, with seven month -old son Shaveli ( photo by Maziko Matemba)

Learning by living Mrs. Mary Wandale, a Senior Health Gate Keeper Assistant who has been living in the A daunting yet friendly man in his 70s, community for a long time, works for an Mr. Jackson explained the principals of immunisation advocacy project led by the Zionism and stressed that their faith Health and Rights Education Programme heals them from illnesses. However, he (HREP), a CSO promoting community allowed the team to talk to Mary John involvement in immunisation and health directly. system strengthening. HREP initiated an intervention which mobilised various Win some and lose some stakeholders to go and approach this Though Shaveli, Mary John’s son, looked community and convince them to access healthy, he was at risk of contracting existing health services, including vaccine-preventable diseases in the immunisation, in the area. future. The team advised and counseled Mary John on the importance of Impact of the GAVI CSO project immunisation. As a result, Mary John and The stakeholder team met with the her husband agreed to take their son, village head, Molosoni, who was and all other children born to them in the concerned about the lack of health future, to be immunised. She still would services being sought by the Zionist not go to the hospital for delivery or any community. He informed the team that other health service, but this inroad with the critical person to influence was sect Mary John and Pastor Jackson will surely leader and Zion pastor, Mr. Jackson. The serve as an entry point into this religious team visited Mr. Jackson prior to group. approaching Mary John’s family.

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GAVI CSO SG2 platform— E2: Kahindo Motogari, Pygmy Woman in the

DRC DRC, Involved in Vaccine Sensitization

(RENADEF) funded by the GAVI CSO Nicole Shabani SG2 country platform project. Catholic Relief Services In July 2012, Ms. Kahindo participated in Zaina Nyombo a training to learn how to raise Réseau National des ONG awareness of the risks of Mother-to-Child pour le Développement de la Femme (RENADEF) transmission of HIV and the importance of immunisations for children in her Benoit Mibulumukini community. This training helped Ms. SANRU Kahindo to strengthen her role as a leader among the Pygmy people in her Assy Lala community. She has been active in SANRU community-based activities to promote vaccination and safe reproductive health practices. She has already led five sessions (from July –September 2012) in Kahindo Motogari and her daughter two different villages including Nehema 24 months old, after a Mubambiro, her native village. sensibilisation session in the field with women of a Mubambiro. Challenges Encountered (Picture taken by John LUANDA) Pygmy women have been marginalized for years relative to other women in the Ms. KAHINDO MOTOGARI, 35 years old community; however, Ms. Kahindo’s and mother of three, is originally from the participation in RENADEF-supported village of Mubambiro located in the activities has helped her to integrate into Kamuronsa sector of the Nord-Kivu the community and play a leadership role province in the east of the DRC. among her peers. The different trainings Marginalized most of her life as a Pygmy supported by RENADEF have allowed woman, Ms. Kahindo Motogari is finally her to share what she has learned with exercising her rights as a woman with the others in her community, especially on support of Réseau National des ONG activities that were not well accepted pour le Développement de la Femme before, such as vaccinations.

E3: Vaccinating Disadvantaged Children in one of Nairobi’s Biggest Slums

Christian Watanabe Alice Health Services was established in Alice Health Services 2005 as a community-based organisation that provides healthcare services to the community of Mukuru Kwa Njenga in Nairobi, a slum area with a population of over 101,000. Its mission is to scale-up the output-based approach system to enable disadvantaged groups to access affordable health care services and education. For many of the area’s residents, the clinic’s fee at 30 shillings (US $.35) is the most affordable and only option. Continued...

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In addition to immunisations, the clinic’s parents who have defaulted in ten staff members also provide curative immunisations. This is an innovative way and rehabilitative services, maternity to ensure no child misses out on the care, maternal child health services, vaccination program. The CHWs also family planning, PMTCT, VCT, and ensure there is equity and gender laboratory tests. balance, so no child misses his or her vaccinations. There are challenges, Role of the clinic in immunisation however, and the clinic often runs out of In Mukuru Kwa Njenga slum vaccines, particularly polio and BCG. On Saturdays, the clinic hosts an immunisation drive to vaccinate children The clinic has been selected to be the against tuberculosis, polio, measles, and center of immunisation in Mukuru Kwa pneumococcal pneumonia. Njenga slum during the recently launched national immunisation campaign program The clinic’s target population is 5,218, against measles. and it reports to the Division of Vaccines and Immunisation (DVI) within the Ministry of Health (MOH) every month on the number of children immunized.

The September data was as follows: • BCG 67 • Polio 144 • DPT/Hep 77 • Pneumococcal 77 • Measles 63

The clinic’s vaccine program is sustainable because it receives vaccines supplies from the Kenyan government free of charge. The clinic has also engaged the services of two community health workers (CHWs) to conduct community outreach and follow up with

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E4: Editorial: Immunisation for All: Empowering Communities To Ensure No

Child is Left Behind

Great strides have been made in Department of Health, initially introduced Kirsten Mathieson immunisation, with global coverage child health cards in Penjikent District as Save the Children UK increasing from 74% in 2000 to 83% part of a project to strengthen routine 1 currently . However, global progress immunisation. Armed with knowledge masks inequalities across and within about how to protect their children’s countries. One in every five children is health, a schedule of immunisation still not receiving even the most basic services, and the child health card, 2. vaccines Children from the poorest and parents were empowered to demand most remote areas and the most services. Previously, the responsibility for 1 disadvantaged groups are often left immunisation rested exclusively with the Based on global DTP3 coverage. behind. WHO, 2012. Global and regional health worker. immunisation profile . Geneva: WHO. Available at: To address these inequalities will require Following the success of the pilot project, http://apps.who.int/immunisation_ concerted effort at all levels. Within UNICEF worked with the government monitoring/en/globalsummary/GS_ countries, strong routine immunisation is and Save the Children to advocate for GLOProfile.pdf 1 crucial. Immunisation systems can the nationwide introduction of child health This refers to the 22 million potentially bring otherwise excluded cards. Now part of national policy, health children worldwide aged 12–23 children into the reach of essential health months who have not received cards are given to all mothers after services. Engaging with communities three doses of the diphtheria- delivery and families are required to tetanus-pertussis (DTP) vaccine. should be part of any strategy to reach show them when a child starts school Source: WHO, 2012. Global and the hard-to-reach. Where communities and before admission to hospitals and regional immunisation profile. know their rights, are aware of the clinics. Geneva: WHO. Available at: benefits of health services, and know http://apps.who.int/immunisation_ where, when and how to access them, Save the Children’s upcoming report, monitoring/en/globalsummary/GS_ 3 GLOProfile.pdf vaccination coverage is higher . Immunisation for all: No child left behind 1 looks at the importance of improving Shea, B., Andersson, N. and Henry, D., 2009. Increasing the As seen in Tajikistan, simple tools such equity in immunisation. Download the demand for childhood vaccination in as child health cards can help empower report at: http://bitly.com/QtllQO. For hard developing countries: A systematic communities, contributing to better copies, please contact Kirsten Mathieson review. BMC Internat Health and immunisation outcomes. Save the at: [email protected] Human Rights, 9(Suppl 1): S5. Children, in partnership with the District

E5: The REAL Awards: Honoring Health

Workers like Rekha Bangarwa

You’ve probably never heard of Rekha Bangarwa.

She’s not a famous actress or singer. She doesn’t have her own TV show and she’s never competed in the Olympics. Yet Rekha is a Mary Beth Powers celebrity—at least in her own village Newborn and Child Survival of Sakaptur, India. Why? Because Campaign Chief, Save the she is doing the most important Children work a person can do: she’s saving lives. Continued…

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And while she’s never won an Oscar, she According to Dr. Chandan Kachru, who has been selected as one of the global helped train Rekha, people accept honorees for the inaugural REAL community health workers more than Awards, a first -of-its kind global awards anyone coming from the outside. ―When platform designed to honor the unsung a stranger comes in, they think that heroes who have touched people’s lives person has an agenda,‖ Dr. Kachru through extraordinary service in health noted. ―They get suspicious.‖ But care. because Rekha is from the community she serves, people listen to her and heed Rekha is a trained community health her advice. worker. In this role, she educates the members of her village about the basic Rekha’s efforts are bearing fruit. Thanks steps they can take to improve their to her and other health workers like her, health. One of her main duties has been India has not seen a single case of polio to administer oral polio vaccine to the in more than 18 months. For a country children of her community. ―When we first that just three years ago had more polio started going house to house to cases than anywhere else in the world, administer the polio drops, parents were this is no small feat—and certainly merits afraid and would hide their children,‖ a REAL Award, at the very least. Rekha said. ―Now, parents are coming to Visit The REAL Awards website at us on their own.‖ This change is a www.theREALAwards.com to read more testament to Rekha’s persistence and the inspiring stories of health workers like trust she has worked hard to cultivate Rekha from around the world and show among her neighbors. your support.

Reaching every child with immunisation

CSO Constituency contact

information

GAVI CSO Constituency Communications Focal Point

Email amy.dietterich@ ifrc.org

Tel. +41 (0)22 730 4527

Website

www.gavicso.org

The Dose editorial About the Constituency team: The GAVI Alliance CSO Constituency consists of a broad network of over 200 CSOs. The Constituency – which adopted a Charter in Rosemary Anderson Akola December 2010 outlining how it functions – consists of two layers: a Sabrin a Bakeera-Kitaka broad civil society Forum and a core CSO Steering Committee. Find us Kelly Coppenrath on the web at http://www.gavicso.org/. Amy Dietterich Mayowa Joel The Forum functions through periodic in-person meetings and a Jamee Kuznicki general email listserv at [email protected] Clarisse Loe Loumou where ideas, information and new developments are exchanged and debated. Any organisation is welcome and encouraged to join this Angela Pereira group.