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1 Report of the Menafrivac Supervision Campaign in The REPORT OF THE MENAFRIVACTM SUPERVISION CAMPAIGN IN THE REGION OF DIOURBEL Report presented by: Doctor Hassane YARADOU National Immunization Technical Advisor MCHIP/USAID SENEGAL 1 SUMMARY Cerebro-spinal meningitis (CSM) is a real concern in Africa, in particular related to meningococcal A. It is responsible for meningitis epidemics in the meningitis belt stretching from Ethiopia to Senegal. In order to address this concern, African countries have appealed to the WHO and its partners to find a solution to the recurrent epidemics outbreaks of meningitis meningococcal A. Thus, the MVP was established in 2001 by a partnership between WHO and PATH, funded by the Bill and Melinda Gates Foundation, with a goal “to eliminate epidemics of meningitis as a public health problem in sub-Saharan Africa through the development, certification and the extensive use of a conjugate vaccine combined with affordable cost”. The new conjugate meningococcal A vaccine MenAfriVacTM has been developed and will be introduced by a mass vaccination campaigns to all people aged from 1 - 29 years old. This age demographic will receive a single dose of the MenAfriVacTM vaccine. Senegal as part of the "meningitis belt" intends to introduce this vaccine into EPI routine by the year 2015. This introduction was preceded by a preventive vaccination campaign that took place from the 12 to the 21st of November 2012; it targeted the population of 1 to 29 years old, in 35 districts of the 8 regions with high risks (Kaolack, Fatick, Diourbel, Kaffrine, Tambacounda, Kedougou, Sedhiou and Kolda). As part of the implementation of the preventive vaccination mass campaign against meningitis A, the national supervision teams included technical partners deployed in different targeted regions. We were in the center of Senegal in the region of Diourbel to oversee preparations, implementation and follow the regional assessment meeting. The supervision helped to correct some inconsistencies related to the organization of the immunization sessions, the technique of vaccination, vaccines, the cold chain management and the sharp waste management. In addition, the advocacy of national supervisors, mainly partners, with the regional authorities lead to interruption of data retention. At the end, the two reticent districts released the data on J5 and J8. Overall, preparatory activities, the Organization of the campaign, monitoring and management of sharp waste have been well conducted in accordance to the micro-plans with satisfactory results since over 95% of the targets have been covered in the region. I. OBJECTIVES OF THE SUPERVISION - Ensure the effective start of the activities in accordance with the developed micro-plans o the quality of the training of vaccinators teams o the effectiveness of the implementation of the social mobilization activities and the level of involvement of the local Authorities, Administrative and community representatives o To ensure the proper organization of the immunization sessions and monitor the circulation of vaccination teams based on the strategies developed in microplans and resources available o Ensure the implementation of the plan for the collection and destruction of waste - Provide support in search for solutions to the problems - Provide support to the framework of teams in the regions and districts in the implementation of the supervision of immunization activities - Inquire for existence of AEFI and their care during the campaign - Conduct rapid convenience surveys - Participate in the review and evaluation meetings 2 II. CONDUCT OF THE SUPERVISION 1. Preparatory of Activities Most of the preparatory activities were carried out in a timely manner. They are the following: - microplans and their validation; - Setting-up tools for communication, management tools, human resources, logistics wheels, vaccines, syringes and safety boxes; - Communication activities and proximity sensitization which were led by the mobilizers and public criers recruited and trained; - Information activities to the attention of authorities made within the framework of the Departmental Committees Development (CDD) at the level of departments and chaired by the Prefect (Departmental authority) and Local Development Committees (LDCs) to district level chaired by the Sub-prefects; - Activities of mass media through national radio and particularly local radios - Advocacy targeting administrative, religious and customary authorities, as well as journalists, traditional communicators and other holders of voice; - Training activities, the training of trainers that are members of the regional and district health teams with was held in October 23rd 2012. The training activities at district level were held between the 7th and 10th of November 2012 in different districts. Financial resources have been put in place with a delay of 48 hours. However, this delay did not impact negatively on the implementation of activities. The amounts reported in the micro-plans have been validated except for what concerns the district of Touba which received slightly less than what has been requested The amounts transferred to the Diourbel Region are represented in the table below: Designation / Districts Bambey Diourbel Mbacké Touba RM Social mobilization 2 280 000 2 115 000 1 785 000 2 115 000 542 500 Training 2 876 200 2 475 750 648 1450 5 336 250 00 675 000 Motivation 16 590 000 14, 745, 000 7 715 000 25 704 000 Waste management 400 000 400 000 400 000 800 000 00 608 000 Fuel activities and supervision 800 000 1 000 000 783 264 800 000 Fuel development 80 000 80 000 100 000 00 Evaluation meeting 379 750 266 750 302 000 378 000 394 750 1 827 750 Total 25002950 21 397 700 12 713 714 27 254 250 Local resources were mobilized to support the campaign, mainly for travel (rental), fuel, counterparts of motivation and social mobilization. Below is the amount received by each area: - Bambey: 1 597 000 F CFA - Mbacké: 2 183 955 F CFA - Diourbel: 2 771 736 F CFA - Touba: 8 590 005 F CFA 2. Monitoring the Campaign’s Progress Immunization activities were held in accordance with the micro-plans with fixed sites, secondary advanced sites and mobile sites. The first three days were marked by a very strong participation of population. Queue of people Because of the large participation of the population, we experienced problems the waiting fo vaccination organization of the event, in crowd control and interpersonal communication. Districts such as Diourbel and Bambey have put in place early the organization of immunization activities to gather targeted people such as: schools; "daaras" (Koranic school or Madrasah); the colleges; the University of Bambey and the houses of judgment and Correction (or civil prison). In the other two districts, Mbacké and Touba, these places of gatherings were invested during campaign to J5 and J8. 3 The daily meetings of restitution at the level of districts and the region helped to readjust and adapt the organization of immunization activities. Specifically young people aged 20-29 years old were targeted and children, who usually are with their mothers in markets until late in the afternoon. Regarding communication and social mobilization, the official launch was made by the Governor of the Region of Diourbel. Activities such as the diffusion of spots and radio broadcasts, the sensitization of peoples by mobilizers and public criers and the organization of caravan sensitization took place in the districts. Districts have established partnerships with the press coverage of the campaign and the organization of radio broadcasts. Cases of refusal were managed by supervisors and the Management Committee for rumors and denials. This was the case in Bambey and Diourbel where administrative authorities were involved in handling the refusal cases. There was no negative rumors observed during this Official launch by the Governor of Diourbel campaign and most refusals were related to considerations of non- compliance, personal beliefs or simply the fear of the injection. AEFI case finding has been ensured and record of 37 minor cases of AEFI was registered and cured within the districts. The coordination of the activities of the campaign was assured at the district and regional level by a coordination unit responsible to collect data and coordinate the teams on the grounds. Coordinating mechanisms during the campaign of vaccination against meningitis A were: - the daily debriefing meetings at the level of the districts with the districts health management teams and supervisors from region and national level - the debriefing meetings at the level of the region every two days with the regional health management teams and supervisors from national level Regarding the supervision of immunization activities, districts have defined axes Debriefing meeting of supervision as indicated in the microplans. The region deployed supervisors at regional level in each district. Supervisors from central level including consultants and representatives of institutions such as WHO, UNICEF and MCHIP/ USAID made rotating supervision at the level of the districts. The supervisors permitted to correct gaps related to: the organization of vaccination sites; the vaccination technique; the management of vaccines and cold chain on the vaccination sites; the safety of injections; the waste management; the interpersonal communication and the management of cold chain equipment at facilities level. Health Medical centers that have not met guidelines for mapping and planning of immunization teams trips to be
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